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SPECIAL  NOTE. 

Mr.  John  Barrett,  the  Director  General  of 
the  Pan  American  Union,  an  institution  devoted 
to  the  development  of  comity  and  commerce 
among  the  American  nations,  and  which  acts  in- 
cidentally as  the  office  of  the  International  Sani- 
tary Bureau,  presents  his  compliments  to  the 
readers  of  this  volume,  and,  in  expressing  the 
hope  that  they  will  enjoy  a  perusal  of  its  contents, 
desires  to  state  that  if  they  care  for  special  infor- 
mation concerning  the  Latin-American  Republics 
they  can  obtain  it  by  addressing  him  at  the  Pan 
American  Union  offices,  Washington,  D.  C. 


fa/»v     R^eviccurv     Scum  toL>v"w      ^orr^e.\r€.  rycc  . 

TRANSACTIONS  OF  THE  FOURTH 

INTERNATIONAL  SANITARY  CONFERENCE 

OF  THE  AMERICAN  REPUBLICS 


HELD  IN  SAN  JOSE,  COSTA  RICA 

DECEMBER  25,  1909,  TO 

JANUARY  3,  1910 


PUBLISHED  AND  DISTRIBUTED  UNDER  THE  AUSPICES  OF  THE 
PAN  AMERICAN  UNION,  JOHN  BARRETT,  DIRECTOR- 
GENERAL,  WASHINGTON,  D.  C. 
1910 


I'ress  of  Byron  S.  Adams. 
Washington.  I).  C. 


INDEX. 

PAGES. 

Call  for  the  Fourth  International  Sanitary  Convention 3 

List   of   Delegates    5 

Officers  of  the  Conference 6 

Delegates  of  the  International  Sanitary  Bureaus  of  Washington  or  Monte- 
video    9 

Program  of  the  Fourth  International  Sanitary  Conference 10 

Transactions  of  the  Fourth  International  Sanitary  Conference. 

First  day,  Saturday,  December  25,   1909 — 

Afternoon — Opening  Session    15 

Second  day,  Monday,  December  27,  1909 — 

Morning   Session    28 

Afternoon    Session    32 

Third  day,  Tuesday,  December  28,  1909 — 

Morning   Session    34 

Afternoon    Session    37 

Fourth  day,  Wednesday,  December  29,  1909 — 

Morning  Session    57 

Afternoon    Session    58 

Fifth  day,  Thursday,  December  30,   1909 — 

Morning  Session    64 

Afternoon    Session    67 

Sixth  day,  Friday,  December  31,  1909 — 

Morning   Session    71 

Afternoon    Session    11 

Seventh  day,  Monday,  January  3,  1910 — 

Morning  Session    79 

Afternoon    Session    90 

Appendix : 

Festivities  and  social  functions  in  honor  of  the  delegates 103 

Resolutions  adopted  by  the  Fourth  International  Sanitary  Conference..  105 

Reports  submitted  by  the  different  committees 107 

Propositions  submitted  by  different  delegates 113 

•Letters  concerning  the  Fourth  International  Sanitary  Conference 115 

Reports  presented  by  the  Delegations : 

Chile 119 

Colombia    129 

Costa    Rica    131 

Cuba 151 

El  Salvador 153 

Guatemala 161 

Honduras  163 

Mexico   167 

Panama 175 

United  States   181 

Venezuela  201 


CALL  FOR  THE  FOURTH  INTERNATIONAL 
SANITARY  CONVENTION. 

In  accordance  with  the  resolution  adopted  at  the  Third  International  Sanitary 
Conference,  held  in  the  City  of  Mexico,  December  2-7,  the  date  December 
25,  1909,  to  January  2,  1910,  has  been  fixed  for  the  assembling  of  the  Fourth 
International  Sanitary  Conference  in  the  City  of  San  Jose,  Costa  Rica. 

The  following  official  correspondence  in  regard  to  the  call  and  the  provisional 
program  of  the  Conference  are  printed  in  the  interest  of  the  Conference. 

International  Sanitary  Bureau, 

Washington,  D.  C,  U.  S.  A.,  June  12,  1909. 
Hon.  John  Barrett, 

Director,  Bureau  American  Republics, 
Washington,  D.  C. 
Sir: 

In  accordance  with  the  resolution  adopted  at  the  Second  International  Sani- 
tary Convention  of  American  Republics  authorizing  biennial  conventions,  and  in 
accordance  with  the  action  taken  at  the  last  convention  in  Mexico  City,  Decem- 
ber, 1907,  I  enclose  herewith  a  call  for  the  Fourth  International  Sanitary  Con- 
vention of  the  American  Republics  to  meet  in  San  Jose,  Costa  Rica,  December 
25,  1909,  to  January  2,  1910. 

In  accordance  with  paragraph  7  of  the  resolutions  relating  to  international 
sanitary  police,  adopted  at  the  Second  International  Conference  of  American 
States  in  Mexico  January  29,  1902,  I  have  to  request  that  you  take  such  measures 
as  you  deem  advisable  to  make  announcement  of  this  call. 

It  is  also  requested  that  the  Bureau  of  American  Republics  in  making  this 
announcement  also  make  representations  to  the  government  of  Costa  Rica  in 
order  that  there  shall  be  issued  throtigh  its  Department  of  Foreign  Relations 
invitations  to  the  several  countries  to  be  represented. 

Respectfully, 
(Signed)     Walter  Wyman, 
Chairman,  International  Sanitary  Bureau. 


FOURTH    INTERNATIONAL   SANITARY   CONVENTION   OF   THE 
AMERICAN  REPUBLICS, 

To  Be  Held  in  San  Jose,  C.  R.,  December  25,  1909,  to  January  2,  1910. 
International  Sanitary  Bureau  of  the  American  Republics, 

Wa.>;hington,  D.  C,  June  14,  1909. 

In  accordance  with  the  resolution  adopted  by  the  Second  International  Sanitary 
Convention  of  the  American  Republics,  which  authorizes  biennial  conventions, 
and  in  accordance  with  the  action  taken  at  the  Third  International  Sanitary 
Convention,  it  is  hereby  announced  that  the  Fourth  International  Sanitary 
Convention  of  the  American  Republics  will  be  held  in  San  Jose,  C.  R.,  December 
25,  1909,  to  January  2,  1910. 

It  is  respectfully  urged  that  every  Republic  of  the  Western  Hemisphere  be 
represented  at  this  convention,  both  those  that  have  been  heretofore  represented 
and  those  which  have  not  taken  part  in  the  previous  conventions. 

In  accordance  wdth  resolutions  adopted  at  previous  conventions,  there  will 
be  considered  practical  means  for  the  adoption  of  measures  intended  to  obtain 
the  sanitation  of  cities,  and  especially  of  ports.  This  subject  has,  therefore, 
^een  included  in  the  provisional  program,  which  has  been  prepared  by  the 
President-elect  of  the  coming  convention  with  the  view  to  continuing  the 
work  of  previous  conventions. 


Provisional  Program  for  the  International  Sanitary  Conven- 
tion OF  THE  American  Republics,  to  be  Held  in  San  Jose, 
C.  R.,  December  25,  1909,  to  January  2,  1910. 

1.  Reports  presented  by  the  different  delegates  in  regard  to  the  sanitary  regula- 
tions and  laws  adopted,  and  in  force,  in  their  respective  countries,  since  the 
last  meeting. 

2.  Special  report  by  each  official  delegate  regarding  the  manner  in  which 
the  resolutions  adopted  in  the  three  previous  Conventions  have  been  put  into 
practice  in  their  respective  countries. 

3.  Reports  in  regard  to  sanitary  conditions  in  ports,  and  measures  proposed 
for  the  improvement  of  such  sanitary  conditions  (with  special  reference  to  the 
principal  ports). 

4.  Reports  relating  to  the  registration  of  the  movement  of  population  and 
the  rate  of  mortality  in  each  country,  specifying  those  of  ports  and  principal 
cities. 

5.  Sanitation  of  cities,  and  especially  of  ports. 

6.  Measures  for  the  protection  of  passengers  that  embark  in  vessels  from 
infected  ports. 

7.  Discussion  of  measures  against  the  introduction  of  diseases  not  included 
in  the  Convention  of  Washington  of  1905. 

8.  Sanitary  models  or  forms  to  be  adopted  by  nations  forming  part  of  this 
Convention. 

9.  Discussion  on  sanitary  measures  relating  to  yellow  fever,  bubonic  plague, 
tuberculosis,  malaria,  and  other  diseases,  in  conformity  to  new  discoveries  or 
experiences. 

10.  Discussion  on  measures  relating  to  venereal  diseases. 

11.  Discussion  on  the  necessity  of  the  adoption,  by  the  European  nations,  of 
the  Convention  of  Washington  and  other  sanitary  measures  subsequently 
adopted  by  this  Convention,  with  respect  to  such  colonies  as  they  have  in 
America. 

12.  Discussion  on  new  discoveries  with  respect  to  the  transmission  of  yellow 
fever  and  malaria,  besides  the  mosquito  bite. 

13.  Organization  in  each  country  represented  at  this  Convention  of  a  com- 
mission of  three  physicians  or  health  officers  to  act  as  delegates  of  the  Inter- 
national Sanitary  Bureaus  of  Washington  or  Montevideo,  and  to  form  part 
of  the  International  Sanitary  Information  Committee  of  the  American  Republics. 

By  direction  of  the  International  Sanitary  Bureau  of  the  American  Republics. 

Walter  Wyman, 

C  hair  man. 
Juan  J.  Ulloa, 

Secretary. 


As  requested  in  the  communication  of  Dr.  Walter  Wyman,  Chairman 
of  the  International  Sanitary  Bureau,  the  Director  of  the  International 
Bureau  of  the  American  Republics  has  addressed  a  letter  to  the  diplo- 
matic representatives  of  the  countries  interested  in  the  Conference 
transmitting  a  copy  of  the  call,  and  the  Provisional  Program,  which 
has  also  been  given  to  the  press,  and  will  be  printed  in  the  Bulletin  of 
the  Bureau. 


DELEGATES. 


1.— Colombia Dr.  Martin  Amador. 

r  Dr.  Juan  J.  Ulloa. 

o     /-          r>  J  Dr.  Carlos  Duran. 

2.-C0STA  Rica -^  ^^  j^^^  ^^^^^  S^^  ^ 

L  Dr.  Elias  Rojas. 

3. — Cuba Dr.  Hugo  Roberts. 

4. — Chile Dr.  Manuel  Camilo  Vial. 

5. — El  Salvador Dr.  Alfonso  Quinones  M. 

I  Surgeon-General  Walter  Wyman. 
6. — United  States  of  America Passed  Asst.  Surgeon  J.  W.  Amesse. 

i  Passed  Asst.  Surgeon  R.  H.  von  Ezdorf. 
7.— Mexican  United  States /Dr.  Eduardo  Liceaga. 

I  Dr.  Jesus  Monjaras. 
8.— United  States  of  Venezuela.  ...  ^  Dr.  Pablo  Acosta  Ortiz. 

t  Dr.  Luis  Razettl 

9. — Guatemala Dr.  Nazario  Toledo. 

10. — Honduras Dr.  Fernando  Vasquez. 

11. — Nicaragua Dr.  Vicente  Castro  Cervantes. 

12. — Panama Dr.  Belisario  Porras. 


OFFICERS  OF  THE  CONFERENCE. 

President. 
Doctor  Don  Juan  J.  Ulloa,  Consul-General  of  Costa  Rica  in  New  York. 

Vice-presidents. 

Doctor  Walter  Wyman,  Surgeon-General,  Public  Health  and  Marine  Hospital 
Service  of  the  United  States  of  America. 

Doctor  Eduardo  Liceaga,  President  of  the  Supreme  Board  of  Health  of 
Mexico. 

Doctor  Manuel  Camilo  Vial,  Chile. 

Doctor  Martin  Amador,  Colombia. 

Doctor  Alfonso  Quinones  M.,  Salvador. 

Doctor  Pablo  Acosta  Ortiz,  United  States  of  Venezuela. 

Doctor  Nazario  Toledo,  Guatemala. 

Doctor  Fernando  Vasquez,  Honduras. 

Doctor  Belisario  Porras,  Panama. 

Secretaries. 

Doctor  Luis  Razetti,,  Venezuela  (Spanish  Section). 
Doctor  R.  H.  von  Ezdorf,  United  States  (English  Section). 

Committee  on  Credentials. 

Licenciado  Don  Pedro  Iglesias,  Under-Secretary  for  Foreign  Relations  of 
Costa  Rica. 

Doctor  Belisario  Porras,  Panama. 
Doctor  Nazario  Toledo,  Guatemala. 

Executive  Committee. 

Doctor  Juan  J.  Ulloa,  Costa  Rica. 

Doctor  Walter  Wyman,  United  States  of  America. 

Doctor  Eduardo  Liceaga,  Mexican  United  States. 

Doctor  Pablo  Acosta  Ortiz,  United  States  of  Venezuela. 

Doctor  Manuel  Camilo  Vial,  Chile. 

Doctor  Carlos  Duran,  Costa  Rica. 

Committee  on  Sanitation  of  Ports  and  Cities. 

Doctor  Walter  Wyman,  United  States  of  America. 
Doctor  Jesus  Monjaras,  Mexican  United  States. 
Doctor  R.  H.  von  Ezdorf,  United  States  of  America. 
Doctor  Luis  Razetti,  United  States  of  Venezuela. 
Doctor  Eduardo  Liceaga,  Mexican  United  States. 
Doctor  Jose  Maria  Soto,  Costa  Rica. 

Committee  on  Malaria  and  Yellozu  Fever. 

Doctor  Eduardo  Liceaga,  Mexican  United  States. 

Doctor  Hugo  Roberts,  Cuba. 

Doctor  Carlos  Duran,  Costa  Rica. 

Doctor  Elias  Rojas,  Costa  Rica. 

Doctor  J.  W.  Amesse,  United  States  of  America. 

Doctor  Fernando  Vasquez,  Honduras. 

Committee  on  Measures  for  Protection  of  Passengers. 

Doctor  Carlos  Duran,  Costa  Rica. 

Doctor  R.  H.  von  Ezdorf,  United  States  of  America. 

Doctor  Jose  Maria  Soto  A.,  Costa  Rica. 

Doctor  Pablo  Acosta  Ortiz,  United  States  of  Venezuela. 

Doctor  Nazario  Toledo,  Guatemala. 

Doctor  .A.LF0NS0  Quinones  M.,  Salvador. 


FOURTH  INTERNATIONAL  SANITARY  CONFERENCE. 

Committee   on   Sanitary  Documents. 

Doctor  Hugo  Roberts,  Cuba. 

Doctor  Eduardo  Liceaga,  Mexican  United  States. 

Doctor  J.  W.  Amesse,  United  States  of  America. 

Doctor  Martin  Amador,  Colombia. 

Doctor  Luis  Razetti,  United  States  of  Venezuela. 

Committee  on  Tuberculosis,  Beri-Beri  and  Trachoma. 

Doctor  Walter  Wyman,  United  States  of  America. 

Doctor  ElIas  Rojas,  Costa  Rica. 

Doctor  Jesus  Monjaras,  Mexican  United  States. 

Doctor  MartIn  Amador,  Colombia. 

Doctor  Fernando  Vasquez,  Honduras. 

Doctor  Alfonso  Quinones  M.,  Salvador. 


Members  of  the  International  Sanitary  Bureau  of  Washington. 

CJiairman. 
Surgeon-General  Walter  Wyman,  of  the  United  States. 

Secretary. 
Doctor  Juan  J.  Ulloa,  Costa  Rica. 

Members. 

Doctor  Eduardo  Liceaga,  Mexican  United  States. 
Doctor  Juan  Guiteras,  Cuba. 
Doctor  Pablo  Acosta  Ortiz,  Venezuela. 
Doctor  Rhett  Goode,  United  States  of  America. 
Doctor  Camilo  Vial,  Chile. 


DELEGATES  OF  THE  INTERNATIONAL  SANITARY  BU- 
REAUS OF  WASHINGTON  OR  MONTEVIDEO  AND 
MEMBERS  OF  THE  INTERNATIONAL  SANITARY  IN- 
FORMATION COMMITTEE. 

C  Dr.  RicARDo  DAviLA  Boza. 
Chile <  Dr.  Lucio  C6?doba. 

tOr.  Pedro  Lautaro  Ferrer. 

C  Dr.  J.  M.  LoMBANA  Benetti. 
Colombia -|  Dr.  Ricardo  Amaya  Arias. 

(_  Dr.  Juan  David  IIerrera. 

r  Dr.  Carlos  Duran. 
Costa   Rica    -i  Dr.  ElI as  Rojas. 

tDr.  Jose  Maria  Soto  A. 

j  Dr.  Juan  Guiteras. 
Cuba ^  Dr.  Enrique  B.  Barnet. 

tOr.  ARisTiDES  Agramonte. 

{Dr.  A.  H.  Glennan. 
Dr.  J.  W.  Kerr. 
Dr.  John  W.  Trask. 

TDr.  Eduardo  Liceaga. 
United  States  of  Mexico <  Dr.  Jes6s  Monjaras. 

[.Dr.  Nicolas  Ramirez  de  Arellano. 

f  Dr.  Pablo  Acosta  Ortiz. 
United  States  of  Venezuela <  Dr.  Carlos  Manuel  Cabado. 

t  Dr.  Luis  Razetti. 

rDr.  ToMAs  G.  Palomo. 
El  Salvador -|  Dr.  Francisco  Guevara. 

t  Dr.  Rafael  B.  Castro. 

C  Dr.  Salvador  Ortega. 
Guatemala <  Dr.  Juan  J.  Ortega. 

LDr.  Jose  Azurdia. 

C  Dr.  Jose  M.  Ochoa  Velasquez. 
Honduras -I  Dr.  Ignacio  Castro. 

L  Dr.  Juan  Angel  Arias. 

r  Dr.  Luis  Debayle. 
Nicaragua <  Dr.  Rodolfo  Espinoza. 

t  Dr.  Juan  B.  Sacaza. 

r  Dr.  Luis  Urriola. 
Panama •<  Dr.  Alfonso  Preciado. 

t  Dr.  Augusto  S.  Boyd. 


Program  of  the 

Fourth  International  Sanitary  Convention  of  the 

American  Republics. 

San  Jose,  Costa  Rica. — December  24,  1909,  to  January  3,  1910. 

December  24th 
4  p.  m. — Preliminary  meeting  at  the  Offices  of  the  Secretary  of  Foreign  Affairs. 

December  25th 

3  p.  m. — Inaugural  Session  of  the  Convention  at  the  National  Theater. 
Opening  of  the  Conference  by  the  President  of  the  Republic. 
Address  by  the  Secretary  of  Foreign  Affairs. 
Address  by  the  President  of  the  Convention. 

Brief  address  by  a  member  of  each  Delegation  in  alphabetical  order  of  names 
■of  the  nations  represented. 
Appointment  of  Committees. 
8.30  p.  m. — Gala  performance  at  the  National  Theater. 

December  26th 

9  a.  m. — Visit  of  the  Delegates  to  the  San  Juan  de  Dios  Hospital  and  to  the 
Chapui  Asylum. 

3  p.  m. — Visit  to  the  President  of  the  Republic. 

4  p.  m. — Visit  to  the  Lyceum  of  Costa  Rica,  the  Penitentiary,  and  other  places 
of  the  city. 

December  27th 

9  a.  m. — Reading  of  the  report  that  each  Delegate  must  present  in  the  name 
of  his  country,  containing  the  different  matters  to  which  the  Provisional  Pro- 
-gramme  of  the  Conference  refers  to. 

The  reading  of  reports  by  the  Delegates  shall  be  in  alphabetical  order  of  names 
of  the  nations  represented  at  the  Convention. 

The  time  granted  for  the  reading  of  each  one  of  these  reports  is  limited  to 
15  minutes. 

Those  papers  requiring  a  longer  time  must  be  presented  in  extract;  the 
publication  of  all  subjects  treated  shall  be  made  in  the  respective  Records  of 
the  Fourth  Convention. 

2  p.  m. — Reading  of  Reports  (continued). 

7  p.  m. — Dinner  offered  to  the  Delegates  to  the  Convention  by  the  President  of 
the  Republic  at  the  Presidential  Mansion. 

At  this  dinner  there  will  only  be  two  toa-sts :  the  offering  and  the  response. 

December  28th 

9  a.  m. — Reading  of  reports  (continued). 

Discussion  of  reports  presented  regarding  the  compliance  by  different  countries 
•of  the  resolutions  adopted  at  the  previous  Conventions. 

2  p.  m. — Discussion  of  the  reports  relating  to  the  sanitary  condition  of  the 
ports,  and  the  measures  to  be  proposed  for  the  correction  of  the  defects  therein 
•found. 

9  p.  m. — Reception  at  the  residence  of  the  Secretary  of  Foreign  Affairs. 

December  2gth 

9  a.  m.~Reports  relating  to  statistical  records  of  population  and  mortality  of 
the  respective  countries,  and  discussion  of  same. 

Discussion  of  papers  presented  in  reference  to  Sanitary  measures  against 
■yellow  fever  and  malaria. 

2  p.  m. — Discussion  of  papers  referring  to  protective  measures  against  tuber- 
wcrulosis,  bubonic  plague,  trachoma  and  beri-beri.  , 


FOURTH   INTERNATIONAL  SANITARY  CONFERENCE.  11 

December  30th 

9  a.  m. — Reading  of  reports  to  be  presented  by  the  different  delegations  with 
respect  to  the  appointment  of  committees  of  three  physicians  referred  to  in 
article  13th  of  the  provisional  programme. 

Discussion  of  papers  on  the  sanitation  of  cities,  and  especially  of  seaports. 

Measures  for  the  protection  of  passengers  embarking  in  vessels  sailing  from 
contaminated  ports. 

December  31st 

9  a.  m. — Discussion  of  the  models  of  sanitary  documents  that  are  to  be  used 
by  the  nations  participating  in  the  Sanitary  Convention  of  Washington. 

Discussion  of  other  subjects  related  to  the  programme  of  the  Fourth  Sanitary 
Convention. 

9  p.  m. — Society  ball  at  the  National  Theater,  dedicated  to  the  Delegates. 

January  ist 
1.30  p.  m. — Visit  to  the  President  of  the  Republic. 

January  2d 
7.30  a.  m. — Visit  to  the  Asylum  of  Las  Mercedes. 

January  3d 

8  a.  m. — Visit  to  the  coffee  treatment  plant  and  plantation  of  H.  Tournon  & 
Co.,  in  San  Jose. 

2  p.  m. — Adjourning  session. 

Discussion  of  the  subject  referred  to  in  article  11th  of  the  Provisional 
Programme. 

Election  of  a  place  where  the  next  Convention  shall  be  held. 

Appointment  of  President  for  the  Fifth  Sanitary  Convention. 

Appointment  of  personnel  of  the  International  Sanitary  Office  of  the  American 
Republics. 

Appointment  of  Committees. 

Brief  address  of  farewell  by  a  member  of  each  delegation,  and  response  by 
the  President  of  the  Fourth  Convention. 

January  4th  and  5tli 

Visit  to  the  Hospital  and  Quarantine  Station  in  Limon. 

Excursion  to  Rio  Banano  and  plantations  of  the  United  Fruit  Co.  in  the  Zent 
Division,  offered  by  the  Company  to  the  Delegates  of  the  Fourth  Convention. 

Note. — The  ordinary  sessions  of  the  Convention  shall  be  held  in  the  Hall 
of  Congress. 

Only  15  minutes  time  will  be  granted  for  the  reading  of  papers  submitted 
to  the  Convention. 

In  the  discussion  of  these  papers  the  Delegates  may  take  the  floor  once  only, 
and  in  exceptional  cases  twice,  for  five  minutes  at  a  time. — Juan  J.  Uli.oa, 
President  of  the  Fourth  International  Sanitary  Convention  of  the  American 
Republics. 


TRANSACTIONS  OF  THE  FOURTH 

INTERNATIONAL  SANITARY  CONFERENCE 

OF  THE  AMERICAN  REPUBLICS. 


Members  of  the  International   Sanitary  Bureau  of  Washington. 


Dk.    Pablo    Acosta   Ortiz, 

Venezuela. 

Dr.  Juan   Guiteras, 

Cuba. 


Dr.  Juan   J.    Ui.loa, 

Costa    Rica, 

Secretary. 

Dr.  Walter  Wyman, 

United   States, 

Chairman. 

Dr.    Eduakiki    Lii  k\(:a, 

Mexicr.. 


Dr.   Manuel  Camilo  Vial, 

Chile. 

Dr.   Rhett  Oioode, 

United  States. 


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FOURTH    INTERNATIONAL    SANITARY    CON- 
FERENCE  OF  THE  AMERICAN    REPUBLICS. 


FIRST  DAY— SATURDAY,  DECEMBER  25,  1909. 
Afternoon — Opening  Session. 

At  three  o'clock  in  the  afternoon  there  assembled  at  the  National 
Theatre  of  the  City  of  San  Jose,  capital  of  the  Republic  of  Costa 
Rica,  the  Delegates  of  the  American  Republics  to  the  Fourth  Interna- 
tional Sanitary  Conference  of  American  Republics,  to  wit :  Dr. 
Martin  Amador,  of  Colombia ;  Drs.  Juan  J,  Ulloa,  Carlos  Duran,  Jose 
Maria  Soto  A.,  and  Elias  Rojas,  of  Costa  Rica;  Dr.  Hugo  Roberts,  of 
Cuba;  Surgeon-General  Walter  Wyman,  and  Passed  Assistant  Sur- 
geons J.  W.  Amesse  and  R.  H.  von  Ezdorf,  of  the  United  States  of 
America;  Drs.  Eduardo  Liceaga  and  Jesus  Monjaras,  of  the  Mexican 
United  States ;  Drs.  Pablo  Acosta  Ortiz  and  Luis  Razetti,  of  the 
United  States  of  Venezuela ;  Dr.  Nazario  Toledo,  of  Guatemala ;  Dr. 
Fernando  Vasquez,  of  Honduras ;  and  Dr.  Belisario  Porras,  of  Pana- 
ma. The  President  of  the  Conference,  Dr.  Juan  J.  Ulloa,  appointed 
Surgeon-General  Wyman  and  Dr.  Liceaga  a  committee  to  escort  the 
President  of  the  Republic,  Honorable  Cleto  Gonzalez  Viquez,  to  the 
stage.  •  This  high  official  was  accompanied  by  the  President  of  the 
Supreme  Court,  Honorable  Alejandro  Alvarado,  the  Secretary  for 
Foreign  Affairs,  Honorable  Ricardo  Fernandez  Guardia ;  the  Secretary 
of  the  Interior  and  Police,  Honorable  Alfredo  Volio ;  the  Secretar}'  of 
the  Treasury  and  Commerce,  Honorable  Alberto  Echandi ;  and  the 
Secretary  of  War  and  Marine,  Honorable  Vidal  Quiroz,  and  by  the 
Committee  just  appointed.  The  inauguration  of  the  Conference  was 
then  begun  in  the  following  manner: 

The  President  of  the  Republic.  The  Fourth  International  Sani- 
tary Conference  is  declared  opened. 

The  Secretary  for  Foreign  Affairs  delivered  the  following 
speech : 

"Mr.  President,  Messrs.  Delegates: 

"We  have  the  pleasure  to  behold  today  a  new  triumph  of  the  notion 
of  fraternity  and  the  sense  of  association  that  are  about  to  transform 
the  world.  For  the  fourth  time  the  American  nations  assemble  to- 
gether for  the  purpose  of  building  in  conjunction  the  strongholds  des- 
tined to  protect  our  lives  against  the  attacks  of  swarms  of  invisible 
foes  that  desolate  us  and  retard  progress.  Such  is  the  grand  task 
entrusted  to  the  illustrious  champions  of  the  most  noble  and  useful  of 
sciences,  whom  we  have  the  honor  to  see  congregated  on  Costa  Rican 
soil. 

"The  regularity  with  which  the  International  Sanitary  Conven- 
tions instituted  by  the   Second  Pan-American  Congress  held  in   the 


16  FOURTH  INTERNATIONAL  SANITARY  CONFERENCE. 

city  of  Mexico  have  taken  place,  is  evident  proof  that  the  majority  of 
the  nations  of  the  Western  Hemisphere  have  recognized  the  indis- 
putable usefulness  and  the  practical  wisdom  of  this  measure,  highly 
justified  by  the  very  important  vv'ork  carried  out  in  1902,  1905  and 
1907,  when  the  first  three  conferences  were  held. 

"In  this  era  of  intense  civilization  in  which  the  will  of  the  people 
reigns  over  that  of  the  rulers,  the  peaceful  struggles  have  a  greater 
tendency  every  day  to  offset  those  which  require  drastic  measures 
to  decide  difficult  issues ;  but  these  new  engagements,  however  peace- 
ful, are  not  less  cruel.  The  brave  soldiers  of  industry  and  com- 
merce, the  self-denying  workers  of  science  perish  by  thousands 
in  the  uninterrupted  forward  march,  and  we  have  hardly  conquered 
an  unremitting  foe  when  hundreds  of  others  with  which  blind  Nature 
afflicts  us,  spring  forth,  because  it  is  a  divine  law  that  no  progress  may 
be  attained  without  a  sacrifice. 

"The  painful  spectacle  of  this  cruel  battle  undoubtedly  inspired  in  a 
thinking  brain — a  brother  of  the  one  that  engendered  the  admirable 
institution  of  the  Red  Cross — the  most  noble  idea  that  gave  life  to 
these  conventions;  and  just  as  in  Geneva  were  framed  the  regulations 
to  ameliorate  as  much  as  possible  the  evils  of  war,  so  in  Washington 
and  in  Mexico  precautionary  measures  were  adopted  against  the 
dangers  derived  from  commercial  relations  that,  while  being  the  most 
solid  foundation  of  prosperity  and  the  best  guarantee  of  peace,  are  a 
constant  menace  to  the  health  of  the  peoples.  The  vessel  loaded  with 
wealth,  messenger  of  civilization  and  bearer  of  the  written  thought, 
very  frequently  happens  to  transport  the  germs  of  the  most  terrible 
epidemics,  transformed  into  a  Herald  of  Death. 

"For  the  radical  isolation  of  olden  times  which,  aside  from  being  in- 
human was  causing  enormous  losses  to  commerce,  modern  science 
has  substituted  means  of  defense  no  less  effective  and  that  which  has 
the  advantage  of  safeguarding  common  interests;  but  in  order  to  at- 
tain the  desired  results  produced  by  these  means,  unity  of  action 
is  indispensable,  and  such  is  the  main  object  of  these  conventions,  the 
healthy  influence  of  which  is  evident  and  which  in  the  future  will  pro- 
duce untold  benefits ;  because  the  work  accomplished  so  far  has  not  been 
confined  to  this  one  point;  public  hygiene  in  all  its  aspects  has  been 
the  subject  of  profound  study  on  the  part  of  the  specialists  who  gave 
it  full  form.  The  eradication  of  yellow  fever,  malaria  and  other 
diseases  that  scourge  many  American  countries ;  the  sanitation  of  cities 
and  particularly  of  seaports,  are  as  many  other  vital  purposes  of  these 
learned  assemblies. 

"One  of  the  problems  that  is  more  powerfully  attracting  the  atten- 
tion of  thinkers  and  statisticians  is  that  of  the  prolongation  of  indi- 
vidual life,  which  is  a  factor  in  the  increasing  prosperity  and  power  of 
the  nations.  The  amounts  of  money  that  are  invested  year  after  year  in 
the  interest  of  hygiene  represent  an  enormous  figure,  and  even  in  coun- 
tries as  small  and  modest  as  this  one,  a  large  portion  of  the  state  reve- 
nues is  devoted  to  the  work  of  sanitation.  Our  delegation  can  tell  you 
that  through  perseverance  and  enormous  expenses  we  have  succeeded  in 
eradicating  yellow  fever  from  our  ports ;  we  have  supplied  with  drink- 
ing water  mostly  all  the  cities  and  towns  of  the  Republic  and  we  have 
constrained  the  propagation  of  leprosy.     And  all  this,  which  seems 


FOURTH  INTERNATIONAL  SANITARY  CONFERENCE.  17 

little  compared  with  what  we  yet  have  to  accomplish,  is,  in  reality,  a 
great  deal,  judging  from  the  number  of  lives  that  have  been  saved. 

**Costa  Rica  is  proud  of  having  been  the  place  designated  for  the 
meeting  of  the  Fourth  International  Sanitary  Convention ;  she  is  proud 
to  have  upon  her  soil  the  eminent  men  delegated  by  the  American  Na- 
tions to  co-operate  with  their  learning  and  experience  in  this  essen- 
tially practical  and  humanitarian  task. 

"Messrs.  Delegates :  in  the  name  of  the  President  of  the  Republic 
and  of  the  Government  of  Costa  Rica,  I  tender  you  a  hearty  welcome, 
and  earnestly  trusting  in  the  success  of  your  labors,  I  hope  that  the 
admirable  task  initiated  in  Washington,  continued  in  Mexico,  and 
which  you  are  now  about  to  consolidate  here,  shall  produce  the  fruits 
that  the  world  of  Columbus  rightly  expects  from  your  learning,  your 
wisdom  and  your  love  for  humanity." 

The  President,  Dr.  Ulloa,  then  spoke  as  follows: 

"Mr.  President,  Messrs.  Delegates,  Ladies  and  Gentlemen  : 
Costa  Rica,  highly  delighted  and  full  of  pride  for  the  distinction  which 
has  been  bestowed  upon  her,  wears  to-day  a  gala  dress,  and  with  open 
arms  extends  a  most  hearty  welcome  to  the  illustrious  guests  who  do 
her  honor  by  their  presence. 

"My  fatherland,  Messrs.  Delegates,  small  in  territory  but  great  in 
high-minded  purposes  and  legitimate  ambition,  greets  you  all  most 
affectionately  and  offers  to  you,  side  by  side  with  a  humble  but  hearty 
hospitality,  her  ardent  wish  that  your  sojourn  amongst  us  may  be 
pleasant,  and  advances  the  concourse  of  her  will  and  meagre  elements 
for  the  accomplishment  of  the  humanitarian  task  which  assembles  here 
today  such  distinguished  guests. 

"You,  apostles  of  a  science  whose  gospel  is  the  prevention  of  the 
desolating  ravishers  of  populations,  that  even  in  the  midst  of  modern 
progress  mercilessly  destroy  life  and  wealth,  are  called  upon  to  con- 
dense, in  wise  measures  of  practical  execution,  the  scientific  discov- 
eries that  the  investigating  genius  of  the  present  time  has  been  wrest- 
ing from  nature,  and  to  whose  beneficial  influence  we  owe  the  control 
of  the  scourges  which  were  being  caused  by  yellow  fever,  cholera, 
bubonic  plague  and  other  diseases  which  are  transmissible  through 
the  channels  of  social  and  commercial  intercommunications. 

"The  profitable  teachings  derived  from  scientific  discussion  must  be 
condensed — as  far  as  the  Convention  which  we  are  inaugurating  here 
today  is  concerned — in  resolutions  and  agreements  tending  to  safe- 
guard our  fellow  citizens  against  the  noxious  effects  of  relentless  foes, 
whose  formidable  strongholds  have  been  stormed  by  the  miscroscope 
and  chemical  reaction,  and  their  booty  delivered  into  the  hands  of  the 
laboratory  and  of  the  clinics,  so  that  those  who  have  charge  of  the 
difficult  task  of  maintaining  public  health  may,  with  perfect  knowledge 
of  the  matter,  determine  the  means  of  which  those  foes  avail  them- 
selves for  their  astounding  propagation,  and  recommend,  accordingly, 
the  proper  measures  to  arrest  contagion. 

"Preventive  hygiene  has  been,  and  shall  continue  to  be,  the  subject 
of  important  study  for  all  those  who  strongly  endeavor  to  prevent  or 
to  diminish  the  limits  of  action  of  contagious  diseases.     Hippocrates, 


18  FOURTH  INTERNATIONAL  SANITARY  CONFERENCE. 

in  his  treaty  on  airs,  waters  and  premises,  written  four  hundred  years 
before  the  coming  of  Christ,  brings  forth  principles  and  measures, 
many  of  which  are  included  today  in  scientific  works  from  the  pens  of 
modern  hygienists.  The  importance  of  several  of  the  articles  from 
the  Code  of  Moses  is  today  recognized  by  health  authorities,  and  the 
good  results  derived  from  their  observance  is  demonstrated,  amongst 
other  things,  in  the  relative  longevity  of  the  Jewish  race. 

"Following  the  text  of  the  maxim,  'a  healthy  mind  within  a  healthy 
body,'  the  Greeks  were  extremely  careful  in  the  hygienic  culture  of 
physical  and  mental  faculties.  The  Romans  left  us  fair  examples  of 
sanitary  engineering  in  their  aqueducts  and  main  sewer. 

"Numerous  examples  of  peoples  and  governments  who  take  great 
pains  to  improve  public  health,  by  enacting  and  enforcing  regulations 
tending  to  prevent  the  propagation  of  diseases  and  to  better  the  physical 
resistance  of  the  human  race,  can  be  found  in  the  pages  of  History. 

"However,  the  development  of  hygiene  as  a  science  is  of  recent 
origin,  and  to  the  English  belongs  the  honor  of  having  been  the  first 
to  give  it  shape  in  the  form  of  State  Sanitation,  with  the  establishment 
of  the  British  General  Register  Office,  in  1838. 

"Since  then  much  work  has  been  done  in  the  conscientious  study  of 
the  definite  principles  of  sanitary  laws,  in  all  the  nations  that  occupy 
an  important  place  in  the  roll  of  civilization ;  and  to  this  end,  the  bac- 
teriological discoveries — through  the  demonstration  of  the  force  of 
microscopic  agents,  as  producers  of  infectious  diseases — have  largely 
contributed  in  the  last  twenty  years. 

"But,  gentlemen,  sanitary  science  is  as  yet  defective,  and  although 
much  has  been  accomplished  within  the  last  few  years  in  the  line  of 
educating  and  conquering  old  and  ignorant  prejudices,  and  attracting 
popular  attention  rapidly  towards  its  importance  and  its  resulting 
benefits,  there  is  yet  much  to  be  done,  and  we  all  must  contribute  with 
our  efforts,  no  matter  how  small  they  may  be,  towards  the  progressive 
advancement  of  a  science  which  seeks  the  betterment  of  humanity, 
and  this  should  be  the  subject  of  primary  attention  for  all  govern- 
ments that  endeavor  to  further  the  wellbeing  of  those  who  have  en- 
trusted them  with  their  interests  and  their  destinies. 

"Not  wishing  to  be  very  lengthy,  I  shall  not  refer  extensively  to  the 
statistics  which  clearly  demonstrate  how  much  we  have  gained  in  the 
world  by  the  enforcement  of  measures  against  smallpox,  cholera, 
plague,  yellow  fever,  tuberculosis  and  other  contagious  diseases,  and 
therefore  I  will  only  refer  here  to  the  following  important  points : 

"Three  hundred  years  ago  the  rate  of  mortality  in  London  was  80 
per  1000;  today  it  is  less  than  17.6  per  1000. 

"In  the  Eighteenth  Century  the  victims  of  smallpox  in  Europe 
reached  the  surprising  figure  of  fifty  millions ;  since  the  discovery  of 
the  vaccine,  smallpox  causes  few  deaths  in  countries  where  vaccina- 
tion is  obligatory  or  where  good  care  is  taken  to  have  this  measure 
properly  enforced. 

"Owing  to  the  ever-increasing  application  of  sanitary  measures,  the 
annual  rate  of  mortality  has  progressively  diminished  in  England,  and 
today  hundreds  of  thousands  of  lives  are  saved,  thanks  to  the  practical 
application  of  hygienic  principles. 


FOURTH   INTERNATIONAL  SANITARY  CONFERENCE.  19 

"In  the  United  States  of  North  America,  according  to  the  census  of 
1900,  the  diminution  in  the  number  of  deaths  per  annum,  as  compared 
with  those  in  1891,  is  reported  as  follows: — In  the  Borough 
of  Manhattan,  of  the  City  of  New  York,  4,780;  in  Cincinnati,  1,200; 
in  Buffalo,  1,000;  in  Albany,  600,  and  in  similar  proportion  in  the 
other  towns  of  the  country.  In  what  is  called  "registered  area  of 
the  United  States,"  which  includes  24,358,177  inhabitants  of  the  popu- 
lation of  cities  of  that  country,  distributed  in  towns  of  8,000  or  more 
inhabitants  and  9,399,634  inhabitants  of  rural  population,  there  was 
a  comparative  difference  in  the  mortality  rate  in  the  years  1890 
and  1905  as  follows,  according  to  reliable  statistics  contained  in  a 
recent  report:  in  diphtheria  it  diminished  from  70.1  per  100,000  to 
19.9  owing  to  the  application  of  the  antidiphtheric  serum ;  in  scarlet 
fever  from  13.6  to  6.8;  in  malaria  from  22.1  to  3.9;  in  typhoid 
fever  from  46.3  to  28.1  ;  in  consumption  from  245  to  168.2.  In  the 
registration  area  the  number  of  deaths  in  general  dropped  from 
19.6  per  1,000  to  16.2.  The  foregoing  proportions  represent  the 
approximate  saving  of  125,280  lives  per  annum,  and  forcibly  dem- 
onstrate the  benefits  derived  from  the  observance  of  sanitary 
prescriptions. 

"From  1866  to  1881  the  yearly  average  of  typhoid  fever  cases 
treated  in  the  hospitals  of  Munich  was  594,  that  is  to  say,  3.32  per 
1,000  inhabitants,  and  the  average  number  of  deaths  from  this  disease 
was  208,  or  1.15  per  1,000.  From  1881  to  1888,  after  the  drainage 
system  and  water  supply  were  improved,  the  yearly  average  of  typhoid 
fever  cases  in  the  hospitals  dropped  to  104,  or  0.42  per  1,000  inhab- 
itants, and  the  average  number  of  deaths  caused  by  the  same  disease 
dropped  to  40,  or  0.16  per  1000  inhabitants. 

"Important  improvements  are  noted  on  the  same  line  in  the  United 
States  of  North  America,  owing  to  the  unremitting  attention  given  to 
sanitary  afifairs  in  the  last  few  years.  Notwithstanding  the  ever-in- 
creasing population  on  account  of  the  landing  of  ignorant  immigrants 
devoid  of  all  sense  of  cleanliness,  the  mortality  rate  of  towns  has  been 
diminished ;  by  the  promulgation  of  sanitary  ordinances  wisely  en- 
acted and  strongly  enforced  ;  by  well  built  and  properly  cared  for 
streets  ;  by  dwelling  houses  constructed  according  to  plans  where  sun- 
light and  proper  ventilation  are  duly  regarded ;  by  the  isolation  of  the 
sick,  the  careful  protection  of  the  healthy  and  the  progressive  educa- 
tion of  the  people,  who  now  begin  to  grasp  the  great  importance  of  the 
improvement  and  maintenance  of' public  health. 

"Within  the  last  fifteen  years  the  mortality  rate  has  been  dimin- 
ished, in  the  citv  of  New  York,  from  25.4  to  18.39  per  1.000;  in  Chicago 
from  19.1  to  13.84;  in  Philadelphia  from  20.76  to  17.68;  in  Boston 
from  23.4  to  18.45,  and  in  similar  proportion  in  the  other  principal 
cities. 

"Unfortunately,  gentlemen,  in  the  large  majority  of  countries  of 
Latin  origin  on  the  American  Continent,  we  cannot  exhibit,  for  the 
present,  reliable  statistics  on  the  subject,  and  we  must  make  super- 
human efforts  so  that  our  peoples — especially  the  present  generation 
and  the  one  that  is  rising  for  the  future — may  grasp  the  importance  of 
sanitary  science ;  to  give  to  education,  from  the  general  hygienic  stand- 
point, an  important  place  in  the  curriculum  of  schools,  and  to  work 


20  FOURTH  INTERNATIONAL  SANITARY  CONFERENCE. 

for  the  diffusion  of  sanitary  principles  by  means  of  lectures,  confer- 
ences, pamphlets  written  in  language  within  the  reach  of  the  general 
public  and  by  practical  articles  in  the  periodical  press. 

"All  contagious  diseases  should  be  constantly  investigated,  and  the 
governments  and  hygienists  should  endeavor  to  diffuse  by  all  possible 
means  the  teachings  obtained  from  their  researches,  pointing  out 
clearly  and  distinctly  the  practical  methods  to  be  employed  by  the 
public,  so  as  to  be  able  to  arrest  their  propagation. 

"Instructors  of  hygiene  and  adequate  literature  within  the  reach  of 
■everybody  should  be  provided  by  governments  and  benefactors  of 
humanity,  and  they  should  punsue  a  restless  campaign  of  sanitary 
education,  because  this  is  the  strongest  weapon  that  we  can  use  in  the 
struggle  for  the  prophylaxis  of  the  communicable  diseases  whose 
scourges  are  diminished  in  a  relative  proportion  to  the  adoption  of 
methods  advised  by  Hygiene,  and  the  vigor  with  which  they  are 
enforced. 

"At  the  three  previous  conventions  we  have  succeeded  in  making 
great  strides  towards  the  development  of  the  plan  which  should  guide 
us  in  framing  up  a  Sanitary  Code,  to  be  obligatory  for  the  present  upon 
all  the  nations  which  constitute  the  American  Continent,  and  which 
shall  be  the  standard  of  action  for  all  the  authorities  who  are  invested 
with  the  duty  of  protecting  the  different  communities  that,  though 
they  may  be  governed  by  different  Constitutions,  are  sheltered  under 
the  same  protective  mantle  of  Sanitary  Science  upholding  the  noble 
i)anner  of  common  welfare. 

"Neither  the  resistance  offered  by  old  prejudices  nor  the  protest  of 
selfish  rights  should  detain  us  in  the  promulgation  of  sanitary  ordi- 
nances, because  judicial  science  as  well  as  medical  science  are  in  con- 
stant evolution,  and  the  very  minute  that  the  latter  discovers  new  prin- 
ciples that  are  incompatible  with  the  present  organization,  the  spirit 
of  the  former  will  also  find  convenient  means  by  which  individual  in- 
terest and  liberty  may  live  in  perfect  harmony  with  public  health. 
And,  gentlemen,  it  matters  nothing  whether  the  present  legislation  has 
not  incorporated  in  its  Codes  all  the  restrictions  which  Sanitary 
Science  regards  as  indispensable ;  it  is  up  to  the  statesmen  to  decide 
the  issue ;  our  calling  is,  over  and  above  everything,  to  determine  the 
best  methods  tending  to  the  improvement  and  maintenance  of  health. 

"The  International  Sanitary  Conventions  of  the  American  Republics, 
which  are  being  held  every  two  years,  are  the  result  of  the  great  in- 
terest taken  by  the  countries  of  this  hemisphere  to  improve  their 
respective  hygienic  conditions  and  to  adopt  uniform  measures  for  their 
mutual  protection  in  order  to  prevent  the  communication  of  such  dis- 
eases as  are  transmissible  by  travelers  and  by  articles  of  commerce. 

"Much  commendable  work  has  been  done  in  the  three  conventions 
held  previously  to  this  one,  and  we  have  made  great  progress  in  the 
road  which  we  have  chosen,  by  adopting  resolutions,  many  of  which 
are  today  the  fundamental  principles  of  regulations  enacted  for  the 
purpose  of  preventing  the  introduction  and  propagation  of  diseases, 
without  placing  unnecessary  hindrances  to  commerce. 

"The  Convention  held  in  Washington  in  1905,  which  was  nothing 
more  than  a  modification  of  the  International  Convention  held  in 
Paris  in  1903,  but  amended  with  important  articles  referring  to  yellow 


FOURTH  INTERNATIONAL  SANITARY  CONFERENCE.  21 

fever,  in  accordance  with  perfectly  defined  principles  of  its  propaga- 
tion through  the  sting  of  the  mosquito  stcgomya  calopus,  has  been 
legally  accepted  by  twelve  of  the  American  Republics,  and  we  should 
endeavor  to  have  the  other  nine  Republics  accept  it  without  delay,  as 
in  this  way  we  should  not  be  compelled  to  adopt  resolutions  resulting 
in  drastic  measures  that  would  hinder  commercial  intercourse  with 
such  countries  as  are  unable  to  offer  the  guarantees  demanded  by  mod- 
ern Sanitary  Science. 

"Important  resolutions  were  adopted  during  the  Convention  which 
was  held  in  the  City  of  Mexico  in  1907,  against  tuberculosis,  malaria, 
trachoma  and  beri-beri.  Many  of  these  resolutions  should  be  incor- 
porated in  the  International  Sanitary  Code,  which  shall  be  the  supreme 
law  of  this  Continent,  as  far  as  sanitation  is  concerned.  During  the 
present  convention  we  must  continue  the  discussion  of  protective 
measures  against  tuberculosis  and  malaria,  and  perhaps  it  would  not 
be  amiss  to  discuss  other  contagious  diseases. 

"One  of  the  most  important  tasks  before  the  Fourth  Convention 
will  be  that  which  refers  to  the  sanitation  of  cities  and  specially  of 
sea-ports,  and  it  is  to  be  hoped  that  the  reports  of  the  Delegates  and 
the  papers  to  be  read  on  this  subject  shall  furnish  the  necessary  data 
for  the  adoption  of  resolutions  tending  to  the  immediate  correction  of 
defects  which  are  at  present  to  be  found  in  the  great  majority  of  the 
ports  of  this  Continent,  which  defects  constitute  a  formidable  menace 
to  countries  having  commercial  intercourse  with  them. 

"We  ought,  therefore,  gentlemen,  to  prevail  upon  our  respective 
governments  for  the  enactment  and  enforcement  of  necessary  ordi- 
nances, so  as  to  make  effective  such  resolutions  as  are  adopted  in  our 
conferences,  and  in  this  way  we  will  prevent  our  travel  and  commer- 
cial communications  from  suffering  the  restrictions  and  limitations  to 
which  said  communications  with  countries,  where  sanitary  laws  are 
neglected,  shall  be  submitted. 

"Inasmuch  as  we  do  not  pretend,  to  all  intents,  to  have  said  the 
last  word  on  that  which  we  have  agreed  upon  at  the  three  previous 
Conventions,  we  must  discuss  the  teachings  derived  from  investigations 
and  practical  experience  in  order  to  modify  in  a  just  manner  such 
prescriptions  as  are  not  in  accordance  with  the  latest  scientific  dis- 
coveries. 

"We  have  already  initiated  relations  between  the  International  Sani- 
tary Office  in  Washington  and  that  of  Paris,  and  it  is  to  be  hoped  that 
in  the  future  we  shall  have  agreed  upon  the  means  to  give  the  Sanitary 
Code,  in  the  framing  of  which  we  are  at  present  occupied,  a  universal 
character,  which  today  is  only  Pan-American. 

"At  least  we  must  insist  upon  the  acceptance  of  our  sanitary  ordi- 
nances by  European  countries,  as  far  as  those  which  have  colonies  in 
this  continent  are  concerned,  and  this  is  one  of  the  other  subjects  which 
shall  be  discussed  during  the  sessions  that  we  are  now  inaugurating. 

"The  uniformity  of  health  bills,  certificates  and  other  sanitary  docu- 
ments in  connection  with  shipping  and  traffic  in  the  ports,  is  of  the 
utmost  importance  and  I  hope  that  this  point  shall  be  decided  at  this 
conference. 

"Gentlemen,  the  task  that  we  have  on  hand  is  very  difficult  indeed, 
and  of  great  import ;  the  community  of  interests  represented  by  the 


22  FOURTH  INTERNATIONAL  SANITARY  CONFERENCE. 

flag  of  Continental  Sanitation  compels  us  to  work  with  a  will  and  to 
learn  from  one  another  so  as  to  complement  the  work,  for  the  execu- 
tion of  which  we  assemble  periodically  under  different  skies,  but  al- 
ways guided  by  the  same  star. 

"Messrs.  Delegates,  may  your  sojourn  in  our  midst  be  a  pleasant 
one  and  may  Humanity  and  Civilization  bless  you  all." 

The  Chairman.  We  shall  now  proceed  with  the  program,  and  in 
accordance  therewith  one  member  of  each  Delegation  shall,  in  alpha- 
betical order,  deliver  a  brief  address.  I  request  that  the  addresses  be 
as  short  as  possible.  The  Delegate  of  Chile  not  being  present,  the 
Delegate  of  Colombia,  Dr.  Martin  Amador,  has  the  floor. 

Dr.  Amador.  Mr.  President,  Mr.  Chairman,  Honorable  Delegates: 
Colombia  is  pleased  to  send,  through  me,  its  cordial  greeting  to  this 
land  of  liberty,  and  stable  order  and  peace,  where  we  have  arrived 
without  any  obstacle,  because  there  is  engraved  in  the  hearts  of  its 
citizens  that  love  for  work  which  uplifts  them,  and  enables  them  to 
advance  in  the  path  of  civilization  and  progress  of  nations. 

Seven  days  ago  I  received  telegraphic  instructions  to  take  part  in  these 
scientific  deliberations,  and  if  the  lack  of  time  prevents  me  from  gath- 
ering the  material  with  which  I  could  offer  my  ideas  in  behalf  of  Ameri- 
can sanitation,  I  can  assure  you  that  Colombia  has  always  directed  her 
efforts  towards  enforcing  sanitary  measures  in  her  ports,  and  that 
from  her  coasts  no  danger  has  ever  come  to  the  safety  of  the  nations 
with  which  she  maintains  commercial  relations.  I  shall  watch  your 
labors  closely,  and  it  shall  please  me  to  inform  the  Government  of  that 
wealthy  and  vast  country  of  the  advanced  ideas  of  the  eminent 
hygienists  among  whom  I  have  the  high  honor  of  occupying  a  place. 
Gentlemen,  I  greet  you  kindly,  and  hope  that  you  will  favor  me  with 
your  good  will. 

The  President.  The  Chairman  of  the  Delegation  of  the  United 
States  of  America,  Surgeon-General  Walter  Wyman,  has  the  floor. 

The  Chairman  of  the  Delegation  of  the  United  States  of 
America.  Mr.  President  of  the  Republic  and  Mr.  President  of  the 
Convention,  Delegates,  Ladies  and  Gentlemen : 

It  is  a  privilege,  on  behalf  of  the  Delegates  from  the  United  States, 
to  express  to  all  of  you  the  pleasure  which  we  have  in  coming  to  Costa 
Rica  to  be  received  so  cordially,  as  we  have  been  received,  and  to 
anticipate,  as  we  do  anticipate,  such  a  pleasant  time  during  the  Christ- 
mas holidays. 

We  are  glad,  not  only  to  meet  in  Costa  Rica,  but  we  are  glad 
to  meet  again  the  Delegates  of  the  several  American  Republics.  We 
believe  that  these  conventions,  held  every  two  years,  are  productive  of 
a  vast  amount  of  good  to  the  people  of  all  the  Republics.  They  are 
educational  in  their  tendency,  and,  more  than  that,  they  bring  together, 
as  from  heart  to  heart,  the  different  peoples  of  our  several  Republics. 

The  American  Delegates,  leaving,  some  of  them  from  Boston  and 
some  of  them  from  New  Orleans,  only  a  few  days  ago,  sailing  down 
the  broad  Atlantic  and  across  the  Gulf  of  Mexico,  have  for  the  first 
time  cast  their  eyes  on  the  beautiful  coast  of  Costa  Rica,  the  "rich 
coast"  ;  and  we  were  greatly  impressed  with  the  beauty  of  the  coast 
and  the  enterprise  and  prosperity  of  its  principal  seaport,  Limon. 


FOURTH   INTERNATIONAL  SANITARY  CONFERENCE.  23 

We  have  not,  of  course,  as  yet  visited  the  other  seaport  on  the 
Pacific,  but  we  found,  President  Gonzalez,  that  there  is  much  more 
than  the  beautiful  coast,  as  we  rode  over  those  mountains  so  grand  and 
beautiful,  alongside  that  magnificent  river.  We  felt  that  we  had  never 
witnessed  scenery  so  picturesque  and  so  grand,  and  since  our  arrival 
in  San  Jose,  the  beautiful  capital  of  your  Republic,  we  have  been 
greatly  impressed  with  its  handsome  buildings  and  fine  parks  and  like- 
wise with  the  hospitality  and  kind  entertainment  which  has  been  ex- 
tended to  us. 

It  seems  to  me,  Mr.  President  of  the  Convention,  that  you  did  wisely 
in  selecting  Christmas  Day  for  the  opening  of  the  Convention.  It  is 
a  day  of  joy,  it  is  a  day  of  Christian  love  and  forethought,  of  expres- 
sions of  good  will  and  hope  for  the  future ;  and  to  begin  a  sanitary 
convention  on  this  day  seems  to  me  especially  appropriate,  for  there  is 
no  class  of  work  in  which  human  intellect  engages  that  is  nearer  to 
the  Christian  religion,  or  more  helpful  to  it,  than  the  work  of  sanitation, 
looking  after  the  prevention  and  elimination  of  diseases,  the  establish- 
ment of  hygienic  conditions  so  beneficial  to  all  classes  from  the  highest 
to  the  lowest,  to  the  rich  and  to  the  poor.  There  is  nothing  more  con- 
ducive to  the  advancement  of  the  virtues  taught  by  Christianity  than 
good  health  and  living  under  proper  conditions.  Moral  reforms  are 
brought  about  better  if  you  have  sanitary  reforms  to  begin  with. 

So  we  look  forward  to  a  very  useful  and  profitable  as  well  as  pleas- 
ant convention. 

In  the  name  of  the  Delegates  of  the  United  States,  I  wish  for  all  of 
our  hospitable  friends  in  Costa  Rica  and  for  all  of  our  brother  Dele- 
gates and  for  all  the  Republics  of  the  Western  Continent  a  Merry 
Christmas  and  many  happy  returns  of  the  day. 

The  President.  The  Chairman  of  the  Delegation  of  the  Mexican 
United  States,  Dr.  Eduardo  Liceaga. 

The  Chairman  of  the  Delegation  of  the  Mexican  United 
States.  Mr.  President  of  the  Republic,  Mr.  Secretary  of  State,  Mr. 
President  of  the  Convention,  Ladies  and  Gentlemen :  The  Mexican 
Delegation  to  the  Fourth  International  Sanitary  Convention  of  the 
American  Republics  has  the  honor,  in  the  name  of  the  people  and 
government  of  the  Mexican  United  States,  to  greet  the  people  and  the 
government  of  Costa  Rica,  a  nation  as  small  in  territorial  extension 
and  population  as  it  is  great  in  the  highmindedness  of  its  inhabitants, 
who,  inspired  by  the  love  of  work  and  the  desire  for  progress,  have 
found  in  peace  the  most  substantial  support  for  the  promotion  of  agri- 
culture, the  expansion  of  its  commerce,  the  prosperity  of  its  industries, 
the  spread  of  the  principles  of  hygiene,  the  isolation  of  the  unfortunate 
ones  who  lack  fortune  or  the  power  of  reasoning,  and  the  extension 
of  public  instruction  to  all  social  classes. 

As  messengers  of  peace,  we  come  to  co-operate  with  our  modest 
contingent  to  the  task  of  our  brothers  from  the  other  Republics  of  the 
American  Continent,  in  seeking  the  best  practical  solution  of  the  scien- 
tific problems  that  confront  the  whole  humanity,  since  that  task  has  for 
its  object  the  preservation  of  health  by  means  of  the  prevention  of  dis- 
eases; the  prolongation  of  life,  and  the  betterment  of  the  human  race. 

The  achievement  of  these  lofty  ideals  is  our  aim.  This  aim  has  per- 
suaded us  to  abandon  our  distant  homes,  to  come  here  and  meet  those 


24  FOURTH  INTERNATIONAL  SANITARY  CONFERENCE. 

who  also  bring  with  them  similar  purposes ;  to  continue  the  war  against 
the  common  enemy — transmissible  disease.  In  the  midst  of  this  cul- 
tured community  of  honest  workers  who  have  given  us  cordial  and 
splendid  hospitality  we  come  to  combine  our  efforts  in  the  benefit 
of  science. 

Gentlemen,  in  the  name  of  the  Mexican  nation,  and  in  declaring 
the  sincerity  of  our  purposes  in  the  discharge  of  the  mission  that  has 
been  intrusted  to  us,  we  greet  His  Excellency,  the  President  of  this 
Republic,  the  Delegation  of  this  country — especially  its  illustrious 
Chairman — our  distinguished  colleagues  of  other  delegations,  the  chil- 
dren of  this  country,  which  is  the  Lacedemonia  of  the  New  World, 
and  the  noble  and  charming  ladies  of  Costa  Rica,  of  whom  we  can 
say,  without  hyperbole,  that  they  are  the  beautiful  half  of  the  human 
race. 

The  President.  Through  an  oversight,  I  postponed  the  Delegate  of 
Cuba,  and  I  beg  him  to  excuse  me  for  the  mistake.  The  Delegate  of 
Cuba  has  the  floor. 

The  Delegate  of  Cuba.  Honorable  President  of  the  Republic; 
Messrs.  Delegates :  The  Republic  of  Cuba,  deeply  interested  in  this 
Conference,  has  honored  me  by  appointing  me  as  its  Delegate. 

In  the  name  of  Cuba  I  have  the  honor  of  greeting  you  and  of 
expressing  the  hope  that  the  fullest  success  will  crown  your  efforts. 

The  President.  The  Delgate  of  the  United  States  of  Venezuela, 
Dr.  Pablo  Acosta  Ortiz,  has  the  floor. 

The  Delegate  From  the  United  States  of  Venezuela.  Mr. 
President  of  the  Republic ;  Mr.  Minister  for  Foreign  Affairs ;  Mr. 
President  of  the  Convention :  The  Delegation  of  Venezuela,  in  hon- 
oring itself  by  taking  seat  in  this  learned  assembly,  fulfills  the  pleasant 
duty  of  presenting,  through  me,  bearing  the  name  of  our  Govern- 
ment, the  homage  of  its  respectful  salutation  to  His  Excellency,  the 
President  of  the  Republic,  and,  in  the  person  of  its  first  magistrate, 
the  cultured  people  of  Costa  Rica. 

It  congratulates  itself  with  its  companions  in  labor,  the  honorable 
representatives  of  the  sister  Republics,  expressing  fervent  hopes  that 
the  scientific  assembly  that  is  being  held  to-day  in  this  interesting  city 
will  be  fertile  in  wise  decisions,  which  will  prove  of  vital  importance 
and  meet  the  transcendental  interests  of  the  different  nationalities  here 
assembled ;  since  we  all  unanimously  desire  to  see  our  beloved  America 
prosperous  and  great,  having  as  our  standard  the  invigorizing  banner  of 
progress,  and  as  our  guiding  inspiration,  that  glorious  liberty  that  our 
forefathers  conquered  so  heroically  and  sealed  with  their  generous 
blood  in  the  fields  of  battle. 

There  is  no  greater  honor  or  glory  than  that  bestowed  today  upon 
this  beautiful  country  that  opens  to  us  its  doors  with  graceful  nobleness, 
to  realize  the  most  interesting  of  codes  and  thus  pay  homage  to  the 
most  humanitarian  of  sciences. 

The  President.  The  Delegate  from  Guatemala,  Dr.  Nazario 
Toledo. 

The  Delegate  From  Guatemala.  Mr.  President;  Messrs.  Dele- 
gates; Ladies  and  Gentlemen:  Having  been  designated  by  the  Re- 
public of  Guatemala  to  represent  it  in  the  Fourth  Sanitary  Conference 
of  the  American  Republics,  I  at  first  hesitated  to  accept  that  honor, 


FOURTH   INTERNATIONAL  SANITARY  CONFERENCE.  25 

but  finally  decided  to  receive  it,  realizing,  as  I  did,  that  in  declining  it 
I  would  have  deprived  myself  of  the  pleasure  of  accompanying  the 
illustrious  doctors  so  justly  appointed  by  the  respective  governments  to 
represent  them  in  this  Conference,  as  I  would  also  have  missed  the  op- 
portunity of  hearing  their  enlightened  lectures  on  the  subject  of 
sanitation  of  ports. 

In  the  name  of  Guatemala,  and  in  the  name  of  humanity,  I  greet 
my  colleagues,  the  distinguished  Delegates  to  the  Fourth  Conference 
of  Costa  Rica,  and  I  congratulate  myself  on  being  among  them. 

The  President.  The  Delegate  of  Honduras,  Dr.  Fernando 
Vasquez. 

The  Delegate  From  Honduras.  Mr.  President  of  the  Republic; 
Mr.  President  of  the  Convention ;  Messrs.  Delegates :  In  the  name 
of  the  Republic  of  Honduras  I  have  the  honor  of  tendering  most 
respectful  greetings  to  the  Government  and  people  of  Costa  Rica,  and 
to  the  distinguished  Delegates  of  the  sister  Republics  of  America. 

Honduras,  in  spite  of  its  financial  difficulty,  is  most  willing  to  co- 
operate to  the  best  of  her  ability  in  the  work  of  sanitation  in  the 
Western  Hemisphere. 

I  am  convinced  that  due  to  the  scientific  experience  and  competency 
of  my  illustrious  colleagues  here  assembled  the  Fourth  International 
Scientific  Conference  will  result  in  manifold  benefits  for  the  Ameri- 
can countries. 

Let  us  not  relax  in  our  efforts,  working  with  firmness  and  resolu- 
tion until  we  can  say  with  pride  that  yellow  fever  has  been  eradicated 
from  America;  that  malaria  has  lost  its  power  of  devastating  cities; 
that  bubonic  plague  and  cholera  have  been  ejected  from  our  shores, 
and  tuberculosis  forced  back  to  its  last  stand. 

Bring  to  us  your  ideas;  we  offer  you  fertile  soil  and  healthful  cli- 
mate. Come  to  help  us  in  our  agricultural  and  industrial  tasks,  and 
co-operate  with  us  in  our  efforts  to  secure  for  all  our  countries  the 
same  height  attained  by  the  most  prosperous  nations  of  the  world. 

The  President.     The  Delegate  from  Panama,  Dr.  Belisario  Porras. 

The  Delegate  From  Panama.  Mr.  President  of  the  Republic; 
Mr.  Secretary  for  Foreign  Affairs ;  Mr.  President  of  the  Convention ; 
Messrs.  Delegates :  In  behalf  of  the  Government  of  Panama, 
which  I  have  the  high  honor  of  representing  in  this  Fourth  Interna- 
tional Sanitary  Conference,  I  bring  here,  in  the  first  place,  a  message 
of  concord  and  affection  for  our  smallest  sister,  the  beautiful  Republic 
of  Costa  Rica,  and  her  worthy  Executive,  the  modest  and  illustrious 
Tribune,  Don  Cleto  Gonzalez  Viquez ;  and  in  the  second  place,  a 
message  of  congratulation  to  all  my  colleagues  in  the  Convention  here 
assembled,  with  the  sincere  wishes  of  my  Government  for  the  com- 
plete success  of  the  labors  to-day  inaugurated. 

The  Government  of  Panama  wishes,  besides,  that  the  great  interest 
that  it  has  in  all  sanitary  questions  be  known  to  all,  it  being  convinced 
as  it  is  that  there  is  not,  nor  can  there  be,  any  human  progress  in  the 
betterment  of  public  hygiene  and  health  which  are  the  basis  of  such 
progress.  The  cities  of  Panama  and  Colon,  transformed,  as  if  by  a 
magic  trick,  from  the  most  unhealthy  cities  into  cities  where  no  infec- 
tious disease  is  known  and  where  even  malaria  has  forever  been  ban- 
ished, are  to-day  proclaiming  thereby,  and  by  the  extraordinary  ad- 


26  FOURTH  INTERNATIONAL  SANITARY  CONFERENCE. 

vances  that  the  Isthmus  of  Panama  has  made  in  less  than  five  years  of 
independent  Hfe,  that  the  sanitation  of  cities  is  closely  interwoven  with 
the  progress  of  civilization  of  nations.  For  this  reason  my  Govern- 
ment is  desirous  of  contributing  and  co-operating  with  all  possible 
means  towards  every  enterprise  that  may  tend  to  that  advance  and 
betterment  of  international  hygiene.  It  is,  therefore,  my  pleasant  duty 
to  make  it  known  to  my  honorable  colleagues  that  all  measures  adopted 
by  this  illustrious  Convention  shall  be  fulfilled  by  my  country  with 
aljsolute  faithfulness. 

The  President.  The  Delegates  from  the  Republics  of  Chile  and 
El  Salvador  will  arrive  from  Puntarenas  inside  of  two  days,  and  in 
one  of  the  following  sessions  we  shall  have  the  pleasure  of  hearing 
their  remarks.  Following  the  same  order  established  in  previous  Con- 
ferences we  shall  now  proceed  with  the  appointment  of  Vice-Presidents. 
I  submit  to  the  consideration  of  the  Delegates  the  followingf  names : 


Vice-Presidents: 

Surgeon-General    Walter    Wyman,    Public 

Health  and  Marine  Hospital  Service  of  the 

United   States United  States  of  America. 

Dr.   Don  Eduardo  Liceaga,   President  of  the 

Supreme  Council  of  Health  of  Mexico Mexico. 

Dr.  Manuel  Camilo  Vial Chile. 

Dr.  Martin  Amador Colombia. 

Dr.  Hugo  Roberts Cuba. 

Dr.  Alfonso  Quinones  M Salvador. 

Dr.  Pablo  Acosta  Ortiz United  States  of  Venezuela. 

Dr.  Nazario  Toledo Guatemala. 

Dr.  Fernando  Vasquez Honduras. 

Dr.  Belisario  Porras Panama. 

The  President.  On  account  of  powerful  reasons,  I  can  not  now 
fulfill  the  duties  assigned  to  me  by  the  First  International  Sanitary 
Conference  of  the  American  Republics  in  appointing  me  as  its  per- 
manent secretary.  Therefore,  I  appoint  as  secretary  to  the  Fourth 
Conference  Passed  Assistant  Surgeon  R.  H.  von  Ezdorf,  Delegate 
from  the  United  States  of  America,  and  Dr.  Luis  Razetti,  Delegate 
from  the  United  States  of  Venezuela. 

(The  Secretaries  took  their  seats.) 

The  President.  Through  an  involuntary  omission  on  my  part,  the 
representative  of  the  International  Bureau  of  the  American  Republics, 
Dr.  Albert  Hale,  has  not  read  his  speech,  and  he  now  has  the  floor. 

The  Representative  of  the  International  Bureau  of  the 
American  Republics.  Mr.  President  of  the  Republic ;  Mr.  Presi- 
dent of  the  Conference ;  Messrs.  Delegates ;  Ladies  and  Gentlemen : 
The  International  Bureau  of  the  American  Republics,  which  I  have 
the  honor  of  representing,  has  close  relations  with  the  International 
Sanitary  Conferences,  and  for  this  reason  nothing  more  natural  than 
that  the  Bureau  should  wish  to  participate  in  this  assembly  so  important 
to  the  cause  of  altruistic  sciences.  I  am  the  bearer  of  the  cordial 
greetings  of  the  Bureau,  and  I  am  officially  intrusted  by  its  Governing 
Board  with  the  mission  to  present  to  this  Conference  the  fervent 
wishes  of  that  body  for  the  good  success  of  your  labors. 


FOURTH  INTERNATIONAL  SANITARY  CONFERENCE.  27 

The  Honorable  John  Barrett,  Director  of  the  Bureau,  and  Dr.  Fran- 
cisco Yanes,  Secretary  of  the  Bureau,  wished  to  have  come  personally 
to  greet  you,  but  as  at  the  present  time  they  have  to  attend  to  the 
completion  of  our  new  building,  they  conferred  upon  me  this  most 
pleasant  privilege,  requesting  me  to  represent  them  and  to  greet  you 
in  their  name. 

Here,  in  this  healthful  and  beautiful  capital  of  one  of  the  twenty-one 
Republics  of  America,  we  are  the  guests  of  the  National  Government. 
On  my  part,  and  as  a  member  of  the  Bureau,  I  wish  to  remind  you — 
hosts  and  guests  alike — that  you  all  have  in  Washington  your  per- 
manent home,  and  that  when  in  the  future  you  shall  have  an  oppor- 
tunity to  visit  that  capital,  that  the  doors  of  the  International  Bureau 
of  the  American  Republics,  which  belongs  to  all  the  children  of  the 
New  World,  are  and  shall  always  be  open  for  you. 

The  President.  This  is  all  that  we  have  to  do  to-day.  The  first 
ordinary  session  of  the  Fourth  Conference  will  be  held  next  Monday, 
at  nine  o'clock  A.  M.,  in  the  Hall  of  Sessions  of  the  Constitutional  Con- 
gress. I  beg  to  remind  the  delegates  to  deliver  their  credentials  to  the 
Secretaries  before  withdrawing  from  the  session.  The  session  is 
closed. 

(The  session  was  closed  at  4.30  P.  M.) 


2^  FOURTH  INTERNATIONAL  SANITARY  CONFERENCE. 


SECOND    DAY— MONDAY,    DECEMBER    27,    1909. 
Morning  Session. 

The  Convention  was  called  to  order  by  the  President,  Dr.  Juan  J. 
Ulloa,  at  9  A.  M.,  the  following  Delegates  being  present:  Dr.  Martin 
Amador,  of  Colombia;  Dr.  Hugo  Roberts,  of  Cuba;  Surgeon-General 
Walter  Wyman  and  Passed  Assistant  Surgeons  R.  H.  von  Ezdorf  and 
J.  W.  Amesse,  of  the  United  States;  Dr.  Eduardo  Liceaga  and  Dr. 
Jesus  E.  Monjaras,  of  the  Mexican  United  States;  Dr.  Nazario 
Toledo,  of  Guatemala ;  Dr.  Fernando  Vasquez,  of  Honduras ;  Dr. 
Belisario  Porras,  of  Panama;  Dr.  Pablo  Acosta  Ortiz  and  Dr.  Luis 
Razetti,  of  the  United  States  of  Venezuela ;  Dr.  Juan  J.  Ulloa,  Dr. 
Carlos  Duran,  Dr.  Jose  Maria  Soto,  and  Dr.  Elias  Rojas,  of  Costa 
Rica. 

The  President.  Before  beginning  the  order  of  the  day,  I  beg  to 
remind  the  Delegates  that  at  seven  o'clock  to-night  will  be  held  the  ban- 
quet that  the  President  of  the  Republic  gives  in  honor  of  the  delega- 
tions to  the  Conference,  and  that  at  noon  a  group  will  be  taken  of 
all  the  Delegates. 

For  the  reading  of  the  reports  to  be  presented  by  the  different  dele- 
gations, we  shall  follow  the  alphabetical  order  of  the  nations  repre- 
sented. The  reading  of  the  reports  shall  be  limited  to  fifteen  minutes ; 
those  which  on  account  of  their  length  may  require  a  longer  time  to 
be  read  shall  be  presented  in  resume,  and  will  be  published  in  full  in 
the  proceedings. 

The  Delegate  from  Chile  being  absent  the  Delegate  from  Colombia, 
Dr.  Martin  Amador,  has  the  floor. 

Dr.  Amador  read  the  extract  appearing  in  the  Appendix. 

The  President.  The  Delegate  from  Cuba,  Dr.  Hugo  Roberts,  has 
the  floor. 

Dr.  Roberts.     (His  report  appears  in  the  Appendix.) 

The  President.  The  Delegate  from  the  United  States  of  America, 
Dr.  Walter  Wyman,  has  the  floor. 

Dr.  Wyman.  (The  report  of  the  American  Delegation  will  be 
found  in  the  Appendix.) 

The  President.  I  think  it  in  order  to  call  the  attention  of  the 
Delegates  to  the  fact  that  they  may  make  such  remarks  as  they  may 
see  fit  with  respect  to  the  reports  just  read,  and  to  the  end  that  all  the 
Delegates  may  be  informed  of  the  most  salient  points  of  the  important 
reports  read  by  Dr.  Wyman,  the  official  translator  of  the  Congress 
will  make  the  corresponding  translation.  Afterwards,  all  those  desir- 
ing to  do  so  may  take  the  floor  to  request  explanations  of  the  Delegates 
from  Colombia,  Cuba,  and  the  United  States  of  America,  and  make 
any  pertinent  remarks  before  proceeding  with  the  perusal  of  the  fol- 
lowing reports. 

In  stating  that  the  Delegates  may  make  such  remarks  as  they  see  fit 
regarding  the  reports  just  read,  I  do  not  mean  that  we  are  going  to 


FOURTH   IxXTERNATIONAL  SANITARY  CONFERENCE,  29 

enter  into  the  discussion  of  the  same,  because  this  is  a  procedure  that 
we  will  take  up  tomorrow ;  I  simply  wanted  it  understood  that  some 
remarks  may  be  made  and  information  requested  in  regard  to  such 
points  as  do  not  seem  very  clear,  so  that  we  may  prepare  ourselves  for 
the  discussion  that  will  take  place  afterwards.  So,  if  any  one  wishes  to 
take  the  floor  he  may  make  the  request  to  that  end. 

(Translation  was  made  of  the  report  of  the  Delegation  of  the 
United  States  of  America.) 

The  President.  There  being  nobody  who  wishes  to  take  the  floor, 
we  shall  proceed  with  the  reading  of  the  reports.  The  Delegate  from 
the  Mexican  United  States,  Dr.  Eduardo  Liceaga,  has  the  floor, 

Dr.  Eduardo  Liceaga  read  the  report  of  the  Mexican  Delegation, 
which  is  found  on  page  167  of  the  Appendix. 

The  Delegate  from  Venezuela,  Dr.  Luis  Razetti.  I  beg  the 
Chairman  to  allow  me  to  postpone  the  reading  of  my  report  until  this 
afternoon's  session. 

The  President.  The  Delegate  from  Guatemala,  Dr.  Nazario  To- 
ledo, has  the  floor. 

Dr.  Toledo.  I  request  the  permission  of  the  President  and  of  all 
my  colleagues  that  I  he  allowed  to  finish  my  report  today  and  read  it 
tomorrow,  because  due  to  the  haste  in  which  I  was  appointed  to  rep- 
resent Guatemala  and  to  my  long  years  of  absence  from  that  Republic, 
I  am  not  as  yet  in  possession  of  all  the  necessary  data. 

The  President.  Granted.  The  Delegate  from  Honduras,  Dr.  Fer- 
nando Vasquez,  has  the  floor. 

Dr.  Vasquez.   (His  report  appears  on  page  165  of  the  Appendix.) 

The  President.  I  request  one  of  the  Vice-Presidents  to  take  the 
Chair  for  a  few  moments.  Following  the  custom  adopted  in  other 
Conferences,  and  according  to  the  alphabetical  order  of  the  nations 
represented,  I  call  upon  the  Delegate  from  Colombia,  Dr.  Amador,  to 
take  the  Chair. 

(Dr.  Amador  took  the  Chair.) 

The  Vice-President.  Following  the  order  established,  the  Dele- 
gate from  Panama,  Dr.  Belisario  Porras,  has  the  floor. 

Dr.  Porras.  (He  read  the  report  that  appears  on  page  175  of  the 
Appendix.) 

(At  this  moment  the  President  again  took  the  Chair.) 

The  President.  If  any  of  the  Delegates  wishes  to  make  any  remark 
in  regard  to  the  reports  of  the  representatives  of  Mexico,  Honduras, 
and  Panama,  he  may  request  the  floor. 

I  beg  the  Delegates  from  Guatemala  and  from  Venezuela,  who  were 
allowed  to  postpone  the  reading  of  their  reports,  to  present  them  in 
the  session  of  tomorrow  morning,  because  in  the  afternoon  session  no 
report  will  be  read,  as  we  shall  proceed  with  the  discussion  of  the 
subjects  that  according  to  the  official  program  we  must  take  into  con- 
sideration. 

Dr.  Porras.     I  request  the  floor. 

The  President.     The  Delegate  has  the  floor. 

Dr.  Porras.  Gentlemen,  a  while  ago  we  had  the  honor  of  hearing 
the  report  of  the  illustrious  physician.  Dr.  Liceaga,  who  represents 
the  Mexican  United  States,  and  this  enlightening  report,  so  worthy 
of  our  praise,  has  given  me  doubt  as  to  one  single  point.     I  will  take 


30  FOURTH  INTERNATIONAL  SANITARY  CONFERENCE. 

the  liberty  to  make  a  suggestion  in  order  that  the  competent  ones  may 
discuss  it.  My  remark  relates  to  the  second  point,  Third  Convention, 
which  says :  "In  the  campaign  against  yellow  fever,  the  States  of 
Yucatan,  Campeche,  Chiapas,  Tabasco,  Oaxaca,  Vera  Cruz,  and 
Tamaulipas  intrusted  the  Federal  Government  with  the  direction  of 
said  campaign.  When  the  epidemic  of  bubonic  plague  appeared  in 
Mazatlan  the  States  on  the  Pacific  littoral  likewise  intrusted  the  Fed- 
eral Government  with  the  direction  of  the  campaign  against  that  dis- 
ease." I  take  the  liberty  to  express  an  opinion  in  regard  to  the  mis- 
sion that  is  given  a  government  in  relation  to  public  health.  I  beg 
to  suggest  the  idea  that  public  health  be  intrusted  to  an  autonomous 
board  with  sufficient  powers  to  act  and  that  shall  be  free  from  admin- 
istrative hindrances  and  obstacles. 

Dr.  Liceaga.  I  am  going  to  make  the  explanation  demanded  by  the 
Delegate  from  Panama.  Undoubtedly,  his  attention  is  struck  by  the 
fact  that  only  certain  States  are  mentioned,  those  being  the  ones  on 
the  Gulf  littoral;  the  same  thing  was  done  with  those  on  the  Pacific 
Coast  when  bubonic  plague  invaded  our  territory.  The  States  have 
complete  independence  in  sanitary  matters  when  the  epidemic  does  not 
invade  the  whole  country. 

I  am  going  to  make  this  statement:  The  Mexican  United  States  are 
independent  from  one  another ;  they  are  sovereign  in  matters  of  public 
legislation ;  they  are  in  the  same  case  as  the  United  States  of  America. 
The  Federal  Government  has  gradually  acquired  for  the  Union  the 
control  over  matters  of  international  sanitary  police ;  but  it  has  not  as 
}-et  all  the  control  that  it  needs.  The  Mexican  Government  cannot, 
the  States  having  the  same  independence,  enact  laws  and  regulations 
applicable  to  all.  But  the  conviction  that  such  a  measure  is  wise  causes 
that  all  the  Federal  States,  when  a  pubhc  calamity  exists,  to  surrender 
their  special  powers  to  the  Executive  of  the  Nation.  It  is  a  fact  that 
such  is  the  national  sentiment.  And  if  I  have  incorporated  that  para- 
graph to  which  the  Delegate  from  Panama  alludes,  it  is  because  I  want 
to  do  justice  to  the  good  sense  that  prevails  in  the  different  States  of 
the  Mexican  Union,  in  surrendering  those  powers  when  epidemics 
spread  throughout  the  nation. 

Is  this  not  the  explanation  that  Dr.  Porras  wishes?  If  he  desires 
another,  I  beg  him  to  say  so,  and  I  shall  answer  him  with  pleasure. 
Anyhow,  I  am  going  to  complete  my  idea. 

I  was  saying  that  the  good  sense  that  obtains  in  the  different  States 
of  the  Mexican  Republic  has  been  manifested  in  this  manner:  That 
they  surrender  their  powers  to  the  supreme  authority  of  the  Federal 
Government,  so  that  it  may  have  control  in  cases  of  epidemics  that 
attack  the  Vvhole  country;  and  as  I  justly  consider  that  those  States 
were  thereby  worthy  of  praise  I  make  mention  of  such  ones  as  had 
vested  their  powers  in  the  Federal  Government  to  stamp  out  yellow 
fever  and  bubonic  plague,  just  as  is  now  being  done  in  the  case  of 
malaria. 

If  this  is  not  the  explanation  that  Dr.  Porras  wanted,  I  am  ready 
to  give  him  the  additional  answers  that  he  may  desire. 

Dr.  Porras.  Indeed,  Mr.  President,  that  is  not  the  explanation  that 
I  had  requested.  I  knew  that  the  Republic  of  the  Mexican  United 
States  was  constituted  according  to  the   federal  system;  that  in  na- 


FOURTH  INTERNATIONAL  SANITARY  CONFERENCE.  31 

tions  having  such  poHtical  constitution  the  States  are  sovereign  and 
independent,  and  the  Federal  Governments  cannot  interfere  with  cer- 
tain legislative  prerogatives  of  the  States. 

But  that  v^^as  not  my  objection.  I  consider  that  governments  are 
good — when  they  are  so — to  look  after  what  is  called  the  safety  of  indi- 
vidual rights,  and  the  maintenance  of  the  guaranties  of  such  rights ;  but 
governments  are  almost  never  good  for  other  things.  At  least,  that  is 
the  way  I  look  at  it.  Governments  are  not  fit  to  be  entirely  in- 
trusted with  public  health,  because  the  bureaucratic  system,  as  a  gen- 
eral rule,  involves  many  obstacles  and  difficulties,  partialities,  and 
weaknesses.  And  public  hygiene  should  be  free  from  all  those  things 
and  requires  a  manner  of  procedure  independent  from  such  obstacles. 

What  I  want  to  say  is  that  there  should  be  established  in  the  Ameri- 
can Republics  boards  of  health  independent  from  the  government, 
with  sufficient  authority  to  act  by  themselves,  and  finally,  really  au- 
tonomous.    That  is  the  point. 

Dr.  Liceaga.  If  that  is  the  idea  of  my  esteemed  colleague,  Dr. 
Porras,  I  can  tell  him  that  such  a  board  exists  in  Mexico.  It  is  called 
"The  Supreme  Board  of  Health,"  and  that  Supreme  Board  is  provided 
with  powers  to  meet  the  requirements  of  which  Dr.  Porras  spoke,  in 
such  a  way  that  my  idea  might  be  defined  in  this  way :  In  cases  of 
epidemics  invading  the  whole  country  there  is  only  one  head  that  thinks 
and  only  one  hand  that  executes.  And  the  proof  of  my  assertion  is 
as  follows :  An  epidemic  of  bubonic  plague  broke  out  in  Mazatlan  in 
the  month  of  October,  1902 ;  on  that  occasion  the  Government  gave 
that  Supreme  Board  of  Health  the  necessary  powers  to  direct  the  cam- 
paign against  the  epidemic  and  to  enforce  it  itself ;  and  so  effective  it 
was,  that  the  assistance  of  the  Federal  Government  never  failed ;  the 
States  surrendered  all  their  powers  to  that  body,  and  the  money  that 
was  obtained  from  national  contributions  was  placed  in  the  hands  of 
said  board  to  be  by  it  spent,  and  the  result  of  all  this  was  that  in  the 
period  of  six  months  the  plague  completely  disappeared  from  the 
State  in  which  it  begun — an  epidemic  that  in  all  the  countries  which 
it  has  invaded  could  not  have  been  eradicated  for  a  long  period ;  for 
instance,  in  San  Francisco,  according  to  the  report  presented  by  the 
illustrious  Dr.  Wyman,  the  epidemic  lasted  until  February,  1908, 
that  is  to  say,  a  period  of  six  years,  because  it  invaded  that  city  in 
1902;  whereas,  in  our  country,  it  prevailed  only  during  a  period  com- 
paratively short,  because  it  broke  out  in  October,  1902,  and  it  disap- 
peared in  May,  1903,  and  since  then  it  has  not  reappeared. 

I  believe  that  the  point  raised  by  my  distinguished  colleague,  Dr. 
Porras,  has  been  fully  explained. 

The  President.  I  must  state  that  the  minutes  of  the  inaugural  ses- 
sion have  not  been  read  because  they  are  not  as  yet  ready,  but  they 
will  be  for  the  session  of  this  afternoon. 

As  we  are  going  to  close  the  session  in  a  little  while  I  beg  Dr. 
Liceaga  to  take  the  floor  for  the  purpose  of  extending  to  the  Delegates 
an  invitation  from  the  Charge  d' Affaires  of  Mexico. 

Dr.  Liceaga.  Gentlemen,  the  Charge  d'Affaires  of  Mexico  has  re- 
quested me  to  invite  you  to  a  reception  that  will  be  held  in  the  Lega- 
tion at  9  o'clock  in  the  evening  of  Wednesday,  the  27th  instant,  which 


32  FOURTH  INTERNATIONAL  SANITARY  CONFERENCE. 

invitation  is  for  the  Delegates  as  well  as  for  theii  families;  and  I,  on 
my  part,  request  them  to  accept  our  hospitality  for  a  few  moments. 

The  PiiESiDENT.  After  the  session  is  closed  the  Delegates  will 
please  gather  at  the  entrance  of  this  building,  as  the  photographer  will 
take  a  group  of  us  all.    The  session  is  closed. 

It  was  11:15  A.  M. 

Afternoon  Session. 

The  Convention  was  called  to  order  at  2:30  P.  M.  by  President 
Ulloa,  the  following  Delegates  being  present :  Drs.  Amador,  Roberts, 
Wyman,  Amesse,  von  Ezdorf,  Liceaga,  Monjaras,  Vasquez,  Acosta, 
Razetti,  Ulloa,  Duran,  Soto  and  Rojas. 

The  Spanish  minutes  of  the  inaugural  session  on  December  25th 
were  read  and  approved. 

The  English  Secretary,  Dr.  von  Ezdorf.  I  beg  to  state  that  the 
English  minutes  of  the  same  session  will  be  presented  in  the  morning. 

The  Spanish  Secretary,  Dr.  Razetti,  read  a  card  from  the  Dele- 
gate of  Panama,  Dr.  Porras,  in  which  he  excuses  himself  for  not  at- 
tending the  session,  because  he  had  to  be  present  at  a  match  of  polo 
which  had  been  dedicated  to  him. 

The  Spanish  Secretary  read  the  report  of  the  Committee  on  Cre- 
dentials, which  is  as  follows : 

"The  undersigned,  members  of  the  Committee  on  Credentials  of  the  Fourth 
International  Conference  of  the  American  Republics,  having  examined  the  Cre- 
dentials of  the  Delegates  to  the  Conference,  as  well  as  the  diplomatic  notes  re- 
lating thereto,  recommend  that  the  following  appointments  be  approved: 

"Colombia :     Dr.  Martin  Amador. 

"Costa  Rica.  Drs.  Juan  J.  Ulloa,  Carlos  Duran,  Elias  Rojas,  and  Jose  Maria 
Soto. 

"Cuba  :     Dr.  Hugo  Roberts. 

"United  States:     Drs.  Walter  Wyman,  J.  W.  Amesse,  R.  H.  von  Ezdorf. 

"Guatemala  :     Dr.  Nazario  Toledo. 

"Honduras  :     Dr.  Fernando  Vasquez. 

"Mexico:     Drs.  Kduardo  Liceaga  and  Jesiis  Monjaras. 

"Panama :     Dr.  Belisario  Porras. 

"Venezuela :     Drs.  Pablo  Acosta  Ortiz  and  Luis  Razetti. 

"San  Jose,  Costa  Rica,  December  21 ,  1909. — Pedro  Iglesias. — Belisario  Porras. — 
Nazario  Toledo." 

The  President.  Dr.  Razetti  has  the  floor  to  read  the  report  of 
Venezuela. 

Dr.  Razetti^  after  reading  the  report  which  appears  on  page  201  of 
the  Appendix,  said : 

I  annex  to  this  report  the  plans  of  La  Guaira  and  Caracas,  wherein 
are  marked  all  and  each  of  the  foci  of  bubonic  plague  which  we  have 
observed,  in  both  of  those  cities.  These  plans  are  at  the  disposal  of 
the  delegates.  I  also  annex  our  sanitary  police  regulations ;  the  ordi- 
nances that  were  enacted  in  fighting  the  plague ;  the  instructions  that 
were  given  to  the  sanitary  officers,  sanitation  squads,  etc. 

We  also  have  a  decree  making  compulsory  the  reporting  of  con- 
tagious diseases ;  the  maritime  sanitary  police  law,  the  decree  making 
vaccination  and  revaccination  compulsory ;  the  demographic  statistics 
of  Venezuela  of  1907,  which  are  the  last  ones  published,  and  several 
other  annexes. 


FOURTH   INTERNATIONAL  SANITARY  CONFERENCE.  33 

As  for  the  rest,  the  Delegation  of  Venezuela  hopes  that  from  the 
decisions  of  this  learned  assembly,  and  as  a  result  of  the  wisdom  of 
the  illustrious  personalities  that  compose  it,  we  shall  derive  many  useful 
and  profitable  lessons  for  our  country. 

The  President.  The  plans,  maps,  etc.,  to  which  the  Delegate  of 
Venezuela  refers  will  be  at  the  disposal  of  the  delegates  in  the  office 
of  the  Secretary  of  the  Conference,  as  well  as  the  other  annexes  re- 
lated to  the  dififerent  reports  that  have  been  presented. 

Dr.  Duran  has  the  floor  for  the  purpose  of  reading  the  report  of  the 
Delegation  of  Costa  Rica. 

Dr.  Duran.  The  Delegation  of  Costa  Rica  has  prepared  a  lengthy 
report  and  for  this  reason  it  would  be  impossible  to  read  it  in  full 
within  the  short  time  allowed  for  the  reading  of  these  reports.  On 
this  account,  there  has  been  prepared  a  resume,  which  I  am  going  to 
read,  having  been  designated  to  this  end  by  my  esteemed  colleague  of 
the  Delegation  of  Costa  Rica,  to  whom  I  am  extremely  grateful  for 
this  honor.  (Dr.  Duran  read  the  resume  referred  to.  The  full  text 
of  the  report  of  Costa  Rica  appears  in  the  Appendix,  page  131.) 

The  President.  If  any  of  the  Delegates  wish  explanations  or  addi- 
tional infonnation  in  regard  to  the  reports  read  by  the  delegates  from 
Venezuela  and  Costa  Rica,  they  may  make  the  request  to  that  end. 
(Nobody  took  the  floor.) 

I  have  the  pleasure  to  inform  the  Conference  that  the  Delegates 
have  been  duly  invited  to  a  polo  match  that  will  take  place  this  after- 
noon in  the  Sabana,  where  all  those  who  wish  may  go  as  soon  as  the 
session  is  closed,  for  they  will  be  in  time. 

Before  closing  the  session,  I  am  going  to  make  a  brief  remark  in 
regard  to  the  Faculty  of  Medicine  of  Costa  Rica  and  to  the  physicians 
of  this  country.  I  have  received  complaints  to  the  effect  that  they 
have  not  been  invited  to  attend  the  inauguration  of  the  Conference  or 
its  sessions.  In  this  respect  I  will  say  that  one  of  the  first  steps  that 
I  had  the  honor  to  take  was  that  of  emphasizing  the  importance  that 
they  should  be  present  at  the  session,  and  to  that  end  I  addressed  a 
note  to  the  Faculty  of  Medicine  inviting  the  physicians  to  be  present. 

As  regards  the  inaugural  session,  I  sent  a  communication  to  the 
Secretary  for  Foreign  Affairs,  requesting  him  to  send  invitations  and 
seats  to  the  Faculty  of  Medicine  to  be  by  it  distributed  among  the 
physicians. 

Therefore,  I  request  the  physicians  to  take  this  remark  into  con- 
sideration and  to  be  so  kind  as  to  do  us  the  honor  of  attending  our  ses- 
sions, for  which  purpose  seats  have  been  reserved  for  all  of  them  in 
the  room  in  which  we  are  holding  the  Conference. 

There  being  no  other  matters  to  be  discussed,  the  session  is  closed. 

(It  was  3:45  P.  M.) 


34  FOURTH  INTERNATIONAL  SANITARY  CONFERENCE. 


THIRD  DAY— TUESDAY,  DECEMBER  28,  1909. 
Morning  Session. 

The  Conference  was  called  to  order  by  Dr.  Ulloa  at  9:45  A.  M.,  the 
following  Delegates  being  present:  Drs.  Amador,  Roberts,  Amesse, 
Wyman,  von  Ezdorf,  Liceaga,  Monjaras,  Toledo,  Acosta,  Porras, 
Razetti,  Vasquez,  Ulloa,  Duran,  Soto,  and  Rojas. 

The  English  minutes  of  the  inaugural  session  were  read  and  ap- 
proved. The  English  minutes  for  the  morning  and  afternoon  sessions 
of  December  27th  were  read  and  approved. 

The  President.  Owing  to  certain  difficulties  in  the  Secretary's 
office,  we  have  been  obliged  to  delay  the  opening  of  the  session,  and  as 
the  Spanish  minutes  for  December  27th  are  not  yet  ready,  I  beg  the 
Delegates  to  excuse  the  reading  thereof  until  this  afternoon's  session, 
about  which  time  I  expect  that  the  Secretary's  office  will  be  in  work- 
ing order. 

Referring  to  the  invitation  of  the  Charge  d'Affaires  of  Mexico,  I 
am  requested  to  state  to  the  Delegates  that  no  special  cards  will 
be  issued,  but  that  the  Delegates  and  their  families  are  all  invited, 
and  they  are  all  expected  to  attend  the  reception  that  is  given  in  their 
honor,  which  will  take  place  in  the  Mexican  Legation  at  nine  o'clock 
in  the  evening.  It  is  understood  that  they  are  to  be  accompanied  by 
the  members  of  their  respective  families. 

The  Delegate  from  Guatemala,  Dr.  Toledo,  has  the  floor. 

Dr.  Toledo.  (See  Appendix,  page  161,  on  which  appears  the  report 
read.) 

The  President.  The  Delegates  wishing  to  make  any  remarks  on 
this  report  by  Dr.  Toledo  may  do  so.  I  would  request  the  delegate 
from  Guatemala  to  be  so  kind  as  to  tell  us  what  sanitary  measures 
have  been  adopted  in  Puerto  Barrios. 

Dr.  Toledo.  Mr.  President,  as  I  have  just  stated  in  my  report,  I 
have  been  able  to  obtain  but  very  little  data.  The  only  thing  that 
I  was  able  to  ascertain  is  that  the  few  cases  reported  of  yellow  fever 
were  immediately  isolated;  that  there  were  built  provisional  hospitals 
provided  with  the  necessary  instruments,  and  with  screen  windows  and 
doors,  and  that  the  disinfection  of  rooms,  etc.,  was  duly  made  to  pre- 
vent propagation.  Because,  as  I  have  said  in  my  report,  the  mosquito 
is  the  only  means  of  transmission  of  yellow  fever ;  therefore,  all  swamps 
were  treated  with  petroleum  and  drained,  as  well  as  organic  substances 
disinfected ;  of  course,  that  is  all  that  it  is  possible  to  do  in  new  ports 
where  sanitation  has  just  been  established  and  where  it  is  not  yet  pos- 
sible to  carry  out  sanitary  measures  according  to  the  hygienic  require- 
ments of  a  port.  And  so  efifectively  were  all  possible  measures  car- 
ried out  that  the  authorities  succeeded  in  preventing  the  spread  of 
yellow  fever,  and,  according  to  the  information  that  I  have  obtained, 
in  the  last  two  years  not  one  single  case  of  yellow  fever  has  occurred 
in  that  littoral. 


FOURTH   INTERNATIONAL  SANITARY  CONFERENCE.  35 

Dr.  Duran.  Dr.  Toledo  is  indeed  seriously  handicapped  in  report- 
ing on  hygienic  conditions  in  Guatemala ;  and  I  want  to  state  here  what 
happened  to  me  with  the  Government  of  that  Republic  before  Dr. 
Toledo  was  appointed  as  Delegate. 

They  sent  me  a  wireless  message  offering  me  the  representation  of 
Guatemala  in  this  Conference,  and  I  requested  them  also  by  wireless 
to  wait  for  my  letter.  In  that  letter  I  said,  in  the  first  place,  that  we 
regret  it  here  very,  much  that  they  should  not  be  able  to  send  a  Guate- 
malan physician,  well  posted  on  the  sanitary  conditions  of  that  coun- 
try and  provided  with  all  necessary  data  to  represent  it ;  and  that  they 
should  have  sent  their  Delegate  from  there,  that  country  being  so  near 
and  belonging  to  Central  America,  and  Coeta  Rica  being  the  place 
selected  for  the  holding  of  the  Conference. 

I  also  said  in  that  letter:  "If  you  do  not  decide  to  send  a  special 
physician,  you  must  remember  that  there  are  Guatemalan  physicians 
here,  and  it  is  only  natural  that  a  Guatemalan  physician  should  rep- 
resent his  country." 

Finally,  I  told  them  that,  if  in  spite  of  all,  they  insisted  that  I  should 
represent  Guatemala,  they  must  furnish  me  with  the  respective  report 
and  all  the  necessary  data. 

Guatemala,  instead  of  doing  so,  has  placed  Dr.  Toledo  in  the  predica- 
ment of  representing  it  v/ithout  data  of  any  kind  whatsoever,  and  for 
this  reason  I  believe  that  we  ought  to  excuse  him.  He  has  done  his 
best ;  he  has  resorted  to  the  Consul  of  Guatem.ala ;  he  has  requested 
data  from  the  Guatemalan  physician  residing  in  this  city,  Dr.  Toledo 
Lopez,  and,  in  a  word,  as  I  have  said,  he  has  done  all  that  he  possibly 
could  do. 

I  believe  that  the  Government  of  Guatemala  has  not  done  what  it 
ought  to  have  done  in  this  case ;  especially  when  in  my  letter  referred 
to  I  told  the  Minister  that  it  was  indispensable  to  have  here  all  the 
necessary  data  in  order  to  represent  Guatemala. 

The  President.  When  I  addressed  my  question  to  the  Delegate 
from  Guatemala,  it  was  not  my  intention  to  make  any  insinuations 
against  Dr.  Toledo.  But  it  happens  that  in  this  Conference  we  must 
depend  upon  exact  information,  because  we  can  not  go  into  the  dis- 
cussion of  questions  related  with  hygiene  unless  we  have  absolutely 
correct  data  upon  which  we  may  base  our  conclusions. 

As  Dr.  Toledo  said  in  his  report  that  the  Government  of  Guatemala 
has  spent  the  sum  of  $2,000,000  in  the  sanitation  of  Puerto  Barrios,  I 
want  to  knov/  which  were  those  sanitation  works.  Because,  when  I 
stopped  at  Puerto  Barrios,  there  was  no  physician  in  that  city. 

Now,  then,  to  affirm  that  no  cases  of  yellow  fever  exist  in  ports 
where  they  do  exist,  gives  rise  to  serious  complications  in  the  resolu- 
tions that  may  be  adopted.  I  know  that  there  have  been  cases 
of  yellow  fever  in  Guatemala  during  the  period  of  time  to  which  Dr. 
Toledo  refers,  as  it  is  recorded  in  the  reports  on  file  in  the  Interna- 
tional Sanitary  Bureau  of  Washington.  For  this  reason,  before  mak- 
ing so  conclusive  an  assertion  in  any  report  presented  in  this  Confer- 
ence, the  Delegates,  I  hope,  will  be  provided  with  the  necessary  data 
with  which  to  support  their  statements,  in  order  to  avoid  any  incidents 
like  the  one  tliat  has  just  occurred. 

Dr.    Toledo.     I   believe   that   the    President   did    not   interpret   my 


36  FOURTH  INTERNATIONAL  SANITARY  CONFERENCE. 

words  correctly,  or  that  I  did  not  know  how  to  express  my  idea  prop- 
erly. I  said  that  the  Government  of  Guatemala  has  recently  appro- 
priated, by  reason  of  that  epidemic,  which  did  not  take  place  in  Puerto 
Barrios  but  fifteen  or  twenty  leagues  inland  where  a  few  cases  of  yel- 
low fever  were  reported,  $2,000,000,  for  the  sanitation  of  Puerto 
Barrios,  with  which  sum  they  have  already  begun  to  import  the  ma- 
chinery and  materials  necessary  for  the  destruction  of  mosquitos, 
which  is  the  only  means  of  transmission  of  yellow  fever.  In  my  re- 
port I  promised  that,  before  the  sessions  are  over,  I  will  give  more 
precise  data  to  be  published  in  the  transactions  of  this  Conference. 

Dr.  Porras.  I  request  the  floor  only  for  the  purpose  of  asking  Dr. 
Toledo  the  following  question :  What  money  is  represented  by  the 
$2,000,000  spent  in  the  sanitation  works  of  Puerto  Barrios? 

Dr.  Toledo.     I  have  not  quite  understood  the  question. 

The  President.  Dr.  Porras  wishes  to  know  if  those  $2,000,000  re- 
ferred to  by  Dr.  Toledo  are  in  American  gold  or  in  Guatemalan  cur- 
rency. 

Dr.  Toledo.  As  Dr.  Porras  knows  very  well,  the  rate  of  exchange 
in  Guatemala  is  very  high ;  and,  therefore,  a  serious  government,  in 
saying  that  it  appropriates  $2,000,000  for  sanitation  works,  does  not 
refer  to  a  money  which  may  have  more  or  less  discrimination  in  the 
market,  as  is  the  case  with  Guatemalan  money.  I  suppose,  therefore, 
that  in  saying  $2,000,000,  they  mean  money  that  can  be  negotiated  at 
par  in  any  of  the  civilized  nations  from  which  such  instruments  and 
materials  are  to  be  imported. 

The  President.  Are  there  any  other  remarks  to  be  made  on  this 
report  ? 

Dr.  Wyman.  I  think  it  would  be  a  good  idea  to  allow  the  Doctor 
to  edit  his  report  when  it  goes  in  with  the  Transactions,  and  make 
such  additions  and  corrections  as  he  may  think  proper  at  the  time,  so 
that  we  can  have  as  full  a  report  as  possible  upon  the  sanitary  condi- 
tions in  Guatemala. 

The  President.  Dr.  Toledo  has  said  that  he  was  expecting  some 
data  and  that  he  would  include  it  in  his  report  as  soon  as  he  received  it. 

Dr.  Amesse.  On  arrival  at  Puerto  Barrios  a  few  days  since,  I 
am  sure  the  Delegates  were  surprised  to  see  that  there  was  no  Port 
Surgeon  there,  and  I  would  like  Dr.  Toledo  to  determine  whether  his 
absence  was  temporary  or  whether  the  Government  has  abolished  that 
office.  I  am  sure  the  office  of  Port  Surgeon  is  a  sine  qua  non  for  per- 
fect sanitation  anywhere,  and  I  should  like  to  know  whether  there  is 
a  regularly  detailed  medical  officer  of  the  Port  at  Puerto  Barrios. 

Dr.  Toledo.  I  must  repeat  what  I  have  said :  That  those  are  very 
important  details  regarding  which  I  have  not  been  able  to  secure  any 
data,  because  I  have  had  no  source  from  which  to  obtain  them;  but  I 
shall  answer  the  question  of  my  distinguished  colleague  in  due  time. 
Perhaps  the  Port  Surgeon  was  at  that  time  absent ;  but,  anyhow,  the 
remark  is  a  very  serious  one  and  the  charge  very  just.  I  shall  request 
from  the  Government  of  Guatemala  the  principal  data  and  I  shall 
emphasize  upon  so  grave  an  omission. 

The  President.  Such  an  omission  is  a  very  important  one.  because 
it  has  been  noticed  several  times ;  wc  stopped  at  Puerto  Barrios  twenty 


Dr.  Juan  J.  Ulloa,  Consul-Gf.neral  of  Costa  Rica  in  New  York; 

Secretary  of  the  International  Sanitary  Bureau  of  Washington,  and  President  of 

the  Fourth  International  Sanitary  Convention,  held  in 

San  Jose  de  Costa  Rica,  1909-1910. 


Surgeon-General  Walter  Wyman,  of  the  United  States  Public  Health  and 
Marine  Hospital  Service; 

President    of    the    First  _  and    Second    International    Sanitary    Conventions    of 

American  Republics,  and  Chairman  of  the  International  Sanitary 

Bureau  of  Washington,  D.  C. 


FOURTH  INTERNATIONAL  SANITARY  CONFERENCE.  37 

days  before  the  Delegates  of  the  United  States  did,  and,  as  I  said  be- 
fore, there  was  no  Port  Surgeon. 

We  have  an  invitation  to  visit  the  National  Library.  All  the  Dele- 
gates wishing  to  accompany  us  will  please  come  immediately  as  I  am 
going  to  adjourn  the  session  until  2  P.  M.,  when  we  shall  enter  fully 
into  the  discussion  of  the  reports  from  the  different  delegations. 

(The  session  was  adjourned  at  10:45  A.  M.) 

Afternoon  Session. 

The  Conference  was  called  to  order  by  President  Ulloa  at  2 :  10  P.  M., 
the  following  Delegates  being  present:  Drs.  Amador,  Roberts,  Wy- 
man,  Amesse,  von  Ezdorf,  Liceaga,  Monjaras,  Toledo,  Vasquez, 
Porras,  Acosta,  Razetti,  Ulloa,  Duran,  Soto  and  Rojas. 

The  Spanish  minutes  of  yesterday  morning's  session  were  read  and 
approved. 

Dr.  Duran.  I  noticed,  Mr.  President,  that  there  has  been  recorded 
in  the  minutes  every  word  said  by  those  taking  part  in  the  delibera- 
tions, and  I  would  request,  if  my  distinguished  colleagues  deem  it 
proper,  that  there  be  recorded  in  the  minutes  only  a  brief  extract  of 
'what  each  one  says  in  the  discussions,  although  the  deliberations  be 
published  in  full  in  the  transactions ;  but  the  reading  of  these  minutes 
in  full  takes  a  great  deal  of  our  time  and,  besides,  we  have  to  listen 
again  to  the  same  discussions  that  we  already  know,  which  has  no 
object. 

I  move  that  this  slight  modification  be  adopted. 

The  President.  My  purpose  in  having  the  minutes  made  in  that 
way  is  that  of  giving  the  delegates  an  opportunity  to  correct  any  point 
that  may  not  be  according  to  the  statements  made  in  the  discussions. 
It  is  done  in  order  to  avoid  complaints  that  have  been  made  on  other 
occasions,  because  the  exact  words  of  the  delegates  were  not  recorded 
in  the  minutes. 

Does  the  Conference  approve  the  remark  made  by  Dr.  Duran  or  is 
there  any  objection  to  its  acceptance? 

Dr.  Roberts.  After  listening  to  the  explanations  given  by  the 
President,  in  consideration  of  which  he  has  decided  that  the  minutes 
be  read  in  full,  I  am  in  favor  of  such  procedure,  because  indeed  it 
enables  us  immediately  to  acquaint  our  Governments  with  tlie  pro- 
ceedings. 

Dr.  Monjaras.  I  agree  with  the  Delegate  from  Cuba,  and  I  be- 
lieve that  the  question  could  be  solved  by  simply  instructing  the  Sec- 
retary to  say  when  reading  the  minutes  "Dr.  So-and-So  said  such  and 
such  a  thing,"  and  those  interested  in  knowing  what  was  said  in  full 
may  go  to  the  office  of  the  Secretary  and  read  the  minutes. 

The  President.  Dr.  Monjaras  says  that  he  agrees  with  Dr.  Rob- 
erts who  in  turn  agrees  with  me ;  but  according  to  the  words  of  Dr. 
Monjaras  he  rather  agrees  with  the  proposition  of  Dr.  Duran.  What 
Dr.  Roberts  wants  is  that  minutes  be  read  in  the  same  manner  as  they 
have  been  heretofore,  so  that  the  necessary  corrections  may  be  made. 

Dr.  Wyman.  Mr.  President,  with  regard  to  the  minutes  today  I 
wish  to  say  that  the  English-speaking  delegates  all  have  read  them. 


38  FOURTH  INTERNATIONAL  SANITARY  CONFERENCE. 

and  I  move  that  the  reading  of  the  minutes  this  afternoon  be  dispensed 
with. 

Dr.  Duran.  I  understand  that  Dr.  Monjaras  wishes  to  harmonize 
everything,  and  to  this  end  he  makes  a  very  proper  suggestion:  That 
there  be  recorded  in  the  minutes  the  discussions  in  full,  just  as  they 
are  taken  down  by  the  stenographer,  and  that  the  Secretaries,  in  read- 
ing said  minutes,  should  only  give  a  resume  of  the  discussion  or  have 
a  resume  ready  for  the  session ;  but  that  the  reading  of  what  we  have 
already  heard  be  dispensed  with,  because  we  lose  the  time  that  we 
really  need  to  discuss  the  important  matters  before  this  Conference. 

Dr.  Wyman.  Mr.  President,  if  I  am  in  order,  I  would  like  to  state 
that  I  believe  I  was  appointed  on  two  committees ;  one  an  Advisory 
Committee  to  which  resolutions  must  be  referred,  and  the  other  a  Com- 
mittee on  Sanitation  of  Sea  Ports,  and  I  would  be  very  glad  to  be  pro- 
vided with  a  list  of  members  of  those  committees.  I  have  not  yet 
received  them. 

(The  proposition  of  Dr.  Duran  was  placed  before  the  Conference 
and  voted  down.  The  minutes  of  yesterday  morning's  session  were 
approved.) 

The  President.  We  shall  continue  with  the  reading  of  minutes 
of  yesterday  afternoon's  session. 

(The  Secretary  read  the  minutes,  which  were  approved  without  dis- 
cussion.) 

The  President.  We  shall  now  proceed  with  the  discussion  of  the 
different  reports  read,  and  it  is  Dr.  Amador's  turn. 

The  delegates  who  wish  to  make  any  remarks  in  regard  to  said  re- 
port may  do  so.     I  understand  that  Dr.  Rojas  wants  to  make  a  remark. 

Dr.  Rojas.     I  have  no  remark  to  make. 

The  President.  Do  any  of  the  other  Delegates  wish  to  make  any 
remark  concerning  the  reports  read? 

We  shall  now  take  up  the  second  subject  of  the  program,  which  is: 
"Discussion  of  reports  regarding  the  compliance  by  different  coun- 
tries with  the  resolutions  adopted  at  the  previous  Conferences,"  For 
this  purpose  we  shall  call  the  nations  represented  in  alphabetical  order, 
and,  therefore,  the  Delegate  from  Colombia  has  the  fioor,  and  he  will 
please  report  to  the  Conference  the  manner  in  which  the  resolutions 
of  previous  Conferences  have  been  carried  out  in  his  country. 

Dr.  Amador.  I  have  no  data  in  which  to  base  my  report  on  the 
subject;  the  only  information  that  I  have  is  that  which  I  have  given 
in  my  report,  and  it  refers  to  the  lazarettos  in  Colombia  and  also  to 
the  aqueduct  in  Cartagena,  which  was  built  two  years  ago,  and  to  that 
of  Barranquilla.  For  that  reason  I  cannot  comply  with  this  point  of 
the  program  as  I  would  like  to  by  making  a  statement  of  what  has 
been  done  in  my  country  in  fulfillment  of  the  resolutions  of  the  Third 
Sanitary  Convention. 

The  President.     The  Delegate  from  Cuba  has  the  floor. 

Dr.  Roberts.  As  I  had  the  honor  of  saying  in  my  report  read 
yesterday,  the  Republic  of  Cuba  has  tried  to  comply  in  so  far  as  pos- 
sible with  the  resolutions  adopted  in  previous  Conferences.  One  of 
the  provisions  of  those  Conventions  is,  that  whenever  quarantinable 
diseases  are  within  the  national  territory,  they  shall  be  immediately  re- 
ported to  the  governments  of  the  different  countries,  specifying  the 


FOURTH   INTERNATIONAL  SANITARY  CONFERENCE.  39 

appearance  of  the  case  and  all  other  details  relating  thereto  which  may 
be  of  interest  to  the  different  governments. 

The  Cuban  Republic  has  complied  with  those  provisions  and  through 
the  Department  of  State  the  different  governments  have  been  notified 
as  to  the  details  concerning  the  cases  of  yellow  fever  which  we  had 
at  other  times,  and  which  disease  we  succeeded  in  completely  eradicat- 
ing long  ago. 

With  respect  to  the  measures  adopted  in  the  ports  of  Cuba,  for  the 
prevention  of  the  introduction  of  quarantinable  or  simply  contagious 
diseases,  easily  spread,  I  must  report  that  Cuba  has  done  all  that  is  pos- 
sible in  order  that  its  territory  should  not  be  invaded  by  said  diseases 
from  the  sea,  exclusively,  which  is  the  only  way  by  which  those  dis- 
eases can  be  introduced  into  the  country ;  and  we  have  succeeded,  be- 
cause, as  I  stated  before,  yellow  fever  was  completely  eliminated, 
cholera  and  plague  have  not  reached  our  territory,  and  for  more  than 
ten  years  not  one  single  case  of  smallpox  has  been  registered  in  Cuba, 
in  spite  of  the  many  cases  that  have  arrived  at  our  ports,  and  which 
were  treated  in  our  quarantine  stations. 

Other  patients  suffering  from  scarlet  fever,  measles,  typhus,  malaria, 
etc.,  who  might  have  been  a  source  of  propagation,  upon  arrival  at 
our  ports  were  removed  to  the  hospitals  for  infectious  diseases,  where 
they  were  treated  until  completely  cured,  thus  preventing  them  from 
becoming  a  menace  to  the  com.munity.  With  respect  to  bubonic  plague 
fortunately  no  case  has  ever  arrived  at  our  ports,  and  vessels  coming 
from  places  where  that  disease  existed  were  not  detained.  But  they 
were  simply  ordered  to  proceed  when  this  measure  was  deemed  wise. 

With  respect  to  yellow  fever,  it  is  practically  impossible  that  any 
case  should  appear  in  our  ports  as  it  used  to  do  in  other  times  not  long 
ago.  The  ports  of  Vera  Cruz  and  Tampico,  in  the  Mexican  nation, 
whence  these  cases  came  most  frequently,  have  changed  completely  in 
their  sanitary  conditions.  Due  to  the  energetic  and  wise  measures 
adopted  by  the  Government  of  Mexico,  the  port  of  Tampico  was  long 
ago  freed  from  yellow  fever ;  and  that  of  Vera  Cruz,  although  not  so 
long  ago,  is  also  in  the  same  sanitary  conditions  as  the  former.  Not- 
withstanding this  fact,  when  I  left  Cuba  there  was  still  a  quarantine 
against  the  vessels  coming  from  Vera  Cruz,  and  this  is  due  to  the  fact 
that  our  territory,  on  account  of  its  tropical  climate,  is  very  easily  in- 
vaded by  yellow  fever,  and  to  the  fact  that  there  are  still  some  cases 
in  the  State  of  Yucatan,  which  might  arrive  in  Cuba  during  the  period 
of  incubation  of  the  disease ;  it  is  also  due  to  the  fact  that  we  have 
failed  several  times  in  our  efforts  to  substitute  observation  in  the  town 
for  quarantine  detention. 

In  order  to  accomplish  this  end,  we  have  made  various  trials  which, 
as  I  have  just  said,  have  failed  because  non-immune  passengers  com- 
ing from  those  ports,  not  attaching  any  importance  to  the  question  that 
we  ask  in  regard  to  the  circumstances  and  place  to  which  they  were 
going  to  reside,  would  give  erroneous  data  or  answers  or  would  re- 
move to  other  places  without  giving  notification  of  their  removal,  and 
still  others,  more  intelligent  than  wicked,  unconscious  perhaps  of  the 
dangers  they  were  going  to  cause,  would  give  an  entirely  different 
address  from  the  real  one;  because  they  had  the  conviction  that  if  they 
were  taken  sick  within  a  certain  time  thev  would  be  removed  to  our 


40  FOURTH  INTERNATIONAL  SANITARY  CONFERENCE. 

hospitals  for  infectious  diseases,  and  in  order  to  evade  the  trouble  that 
such  removal  might  cause  them  had  no  objection  to  expose  the  nation 
to  great  danger. 

However,  I  am  sure  that  if  Mexico  continues  in  the  same  state  of 
affairs  as  it  is  at  present  it  shall  not  be  long  before  that  quarantine  is 
abolished. 

Another  provision  of  the  previous  Conference  is  that  which  recom- 
mends that  there  be  specified  in  the  bills  of  health  issued  to  vessels 
the  death  rate  caused  by  malaria  in  the  respective  ports.  I  will  say, 
gentlemen,  that  in  Cuba  malaria  does  not  constitute  today  a  public 
calamity.  The  campaign  that  has  been  waged  and  still  continues  to 
be  waged  against  mosquitos,  not  only  affects  yellow  fever  but  also 
malaria,  and  this  is,  undoubtedly,  besides  the  sanitary  provisions 
against  epidemic  diseases,  the  reason  why  the  cases  of  malaria  should 
be  very  rare  and  complying  with  the  provisions  of  previous  Confer- 
ences, the  death  rate  caused  by  such  disease  is  specified  in  the  bills  of 
health  issued  to  vessels. 

Besides,  in  the  proposed  models  for  bills  of  health  to  be  issued  by 
the  nations  that  have  adhered  to  this  Convention,  and  which  I  shall 
have  the  honor  to  submit  in  one  of  the  following  sessions,  I  have  made 
provision  for  that  recommendation,  and  in  the  said  model  is  the  proper 
place  for  the  respective  entry. 

The  Government  of  Cuba  has  not  placed  quinine  salts  in  the  free 
list  of  its  tariff.  There  are,  however,  domestic  regulations  compel- 
ling the  attendance  of  all  cases  of  malaria  which  may  occur  in  the 
Republic. 

I  have  not  here  the  program  of  previous  Conferences  and,  there- 
fore, I  do  not  remember  the  other  subjects  in  regard  to  which  I  should 
report. 

(A  copy  of  the  programs  referred  to  having  been  given  to  Dr.  Rob- 
erts by  order  of  the  President,  he  proceeded  with  his  report.) 

Dr.  Roberts.  With  regard  to  the  fifth  resolution,  I  will  say  that 
vaccination  and  revaccination  in  Cuba  are  compulsory,  and  that  they 
are  carried  out  in  the  best  possible  way,  both  as  to  individuals  arriv- 
ing at  our  ports  and  to  those  residing  in  the  Republic. 

In  regard  to  the  seventh  resolution,  recommending  the  governments 
to  carry  on  the  most  active  propaganda  possible  concerning  the  etiol- 
ogy, prophylaxis,  and  treatment  of  malaria,  and  that  they  establish  a 
series  of  public  lectures  on  said  matters  in  the  schools,  shops,  barracks, 
etc.,  I  beg  to  remind  the  Delegates  of  what  I  stated  in  my  report,  that  is 
to  say,  that  the  governments  publish  popular  pamphlets  for  the  purpose 
of  expanding  the  knowledge  on  prophylaxis,  etc.,  of  contagious  dis- 
ease which  are  preventible  by  individual  precautions,  but  at  the  present 
moment  I  do  not  remember  if  any  of  said  pamphlets  refers  to  malaria. 

With  reference  to  the  resolution  recommending  the  different  gov- 
ernments the  non-admittance  to  their  respective  territories  of  immi- 
grants afflicted  with  trachoma  or  beri-beri,  I  can  say  that  the  laws  in 
force  in  Cuba  since  the  creation  of  the  Republic,  and  which  are  com- 
pletely identical  with  those  in  force  in  the  United  States  of  America, 
prohibit  the  immigration  of  persons  suffering  from  trachoma  ;  therefore, 
tliis  provision  has  long  since  been  complied  with.  Beri-beri  very  seldom 
arrives  at  our  ports ;  T  only  remember  a  case  during  a  long  period. 


FOURTH   INTERNATIONAL   SANITARY   CONFERENCE.  41 

which  was  treated  in  our  quarantine  station,  and  after  being  cured  was 
deported  in  one  of  the  vessels  of  the  same  company  that  brought  it  to 
Cuba,  the  case  being  that  of  a  Chinaman  who  was  one  of  the  members 
of  the  crew. 

In  regard  to  the  recommendation  that  the  American  Repubhcs  na- 
tionahze  and  centrahze  the  control  of  sanitary  matters  by  means  of 
proper  legislation,  it  is  gratifying  to  me  to  state  that  there  has  been 
established  in  the  Republic  a  "Department  of  Health  and  Beneficence," 
which  is  vested  with  such  control. 

With  regard  to  the  recommendation  that  the  American  Governments 
take  measures  leading  to  the  prevention  of  the  spread  of  tuberculosis, 
such  as  the  avoidance,  as  far  as  possible,  of  the  use  of  fixed  carpets 
and  curtains,  I  will  say  that  such  use  is  very  limited  in  Cuba ;  its  cli- 
mate is  not  adapted  for  that  sort  of  comfort  and  one  sees  very  rarely 
any  carpets  on  the  floors  of  houses.  As  to  the  use  of  profusely  dis- 
tributed cuspidors,  I  will  say  that  the  law  in  Cuba  requires  that  not 
only  shall  there  be  sufficient  cuspidors  in  all  establishments,  but  also 
that  they  should  be  kept  cleanly  at  all  times ;  expectorating  on  the 
floor  is  also  prohibited. 

Recommendation  is  also  made  for  the  periodical  disinfection  of  rail- 
road cars,  steamer  cabins,  and  dining  room  utensils  before  being 
washed.  As  the  Delegates  must  have  seen  in  the  numbers  of  the  Bulle- 
tin of  Health  and  Beneficence,  which  I  have  had  the  honor  of  annex- 
ing to  my  report,  that  disinfection  on  account  of  tuberculosis  is  done 
in  Cuba  frequently,  although  I  believe  that  there  is  no  special  pro- 
vision compelling  the  disinfection  of  napkins  before  being  washed,  as 
is  recommended  by  that  resolution,  nor  directing  that  napkins  for  the 
use  of  passengers  be  always  kept  in  paper  bags  or  envelopes,  although 
the  recommendations  to  the  effect  that  the  food  be  kept  under  wire 
gauze  covers  have  been  adopted,  even  in  some  cases  instead  of  wire 
gauze  they  are  kept  under  crystal  covers. 

With  reference  to  the  recommendation  of  the  advisability  of  Euro- 
pean nations  adopting  the  sanitary  convention  of  Washington  of  1905, 
with  respect  to  such  colonies  as  they  have  in  America,  I  understand 
that  Dr.  Aristides  Agramonte,  representative  of  Cuba  in  a  European 
Congress,  made  that  proposition  which  I  believe  was  not  welcomed 
with  enthusiasm. 

The  resolution  recommending  to  American  Nations  that  the  bills  of 
health  they  issue  shall  contain  the  same  kind  of  information  has  moved 
me  to  prepare  a  proposed  model  of  bills  of  health  to  be  adopted  by  all 
nations,  and  which  I  shall  have  the  honor  of  presenting  in  due  time. 

Recommendation  is  also  made  as  to  the  advisability  of  establishing 
separate  hospitals  for  the  treatment  of  consumptives.  In  Cuba  there 
has  already  been  established  a  hospital  of  that  kind  and  I  do  not  doubt 
that  more  will  soon  be  organized. 

In  the  sanatoriums  of  the  regional  societies  established  in  Cuba  at- 
tendance is  also  given  that  kind  of  patients,  they  being  isolated  from 
the  rest  and  in  the  best  possible  conditions. 

With  reference  to  the  resolution  that  this  convention  shall  discuss 
and  agree  as  to  the  provisions  to  which  the  vessels,  cargoes,  and  pas- 
sengers shall  be  subjected  at  the  contaminated  port  of  departure  in 
order  to  afford  the  greatest  possible  protection  to  passengers  and  avoid 


42  FOURTH  INTERNATIONAL  SANITARY  CONFERENCE. 

the  occurrence  of  cases  on  board,  I  shall  have  the  honor  of  submitting 
a  proposition  to  the  consideration  of  my  distinguished  colleagues. 

This  is  all  that  I  have  to  report. 

Dr.  Wyman.  Mr.  President  and  Gentlemen:  A  good  deal  of 
what  is  required  by  the  order  of  the  day  is  included  in  the  pre- 
liminary report  which  the  American  Delegation  presented  on  the  first 
day,  but  I  will  review  briefly  what  has  been  done  in  connection 
with  the  various  resolutions  which  have  been  passed  since  the  last 
convention,  though  my  review  may  not  be  in  the  exact  order  of  the 
subjects  as  printed. 

It  would,  however,  take  too  long  to  go  into  detail  with  regard  to  all 
the  States  of  our  Union,  for  there  are  forty-six  States  and  very  many 
seaports,  so  I  shall  try  to  give  you  the  main  points  which  have  been 
covered  in  the  several  States  and  municipalities. 

In  the  first  place,  one  of  the  principal  requirements  by  the  previous 
sanitary  conventions  has  been  the  reporting  of  cases.  That  has  been 
done  by  our  Government  regularly  every  week  in  a  publication  which 
we  transmit  not  only  to  our  own  health  officers  and  the  quarantine  offi- 
cers on  the  coast  but  to  all  our  United  States  consuls  in  foreign  ports, 
and  also  through  the  Ministers  of  the  several  Republics  in  Washington 
to  their  respective  countries.  All  information  that  we  have  concerning 
infectious  or  contagious  diseases,  all  important  sanitary  information, 
is  printed  in  that  weekly  publication.  It  is  known  as  "Public  Health 
Reports,"  comes  out  every  Friday  and  is  mailed  to  all  parts  of  the 
world.  That  publication  is  divided  into  two  parts,  the  first  part  relat- 
ing to  sanitary  conditions  and  reports  of  infectious  diseases  in  the 
United  States,  and  the  second  part  containing  the  same  information 
from  foreign  countries  and  the  insular  possessions  of  the  United  States. 

Now,  if  it  so  happens  that  any  of  the  delegates  here  do  not  receive 
regularly  that  report,  it  would  give  me  great  pleasure  to  see  that  their 
names  are  put  upon  the  mailing  list  so  that  they  may  receive  them  not 
only  through  their  respective  State  Departments  or  official  organiza- 
tions, but  also  direct  from  the  Bureau  at  Washington. 

Thus  we  feel  that  we  have  complied,  and  are  complying  constantly 
in  a  satisfactory  manner  with  the  requirements  of  the  Convention  con- 
cerning the  reporting  of  diseases. 

In  regard  to  quarantine,  within  the  last  year  or  two  the  quarantine 
measures  adopted  by  the  United  States  have  undergone  very  few 
changes.  The  labor  that  has  been  put  upon  these  regulations  in  the 
past  is  telling  in  our  favor,  and  we  believe  that  quarantine  has  been 
going  on  with  as  little  restraint,  as  little  difficulty,  and  as  little  friction, 
both  with  regard  to  the  commercial  interests,  our  own  commercial  in- 
terests and  foreign  commercial  interests,  as  is  compatible  with  exist- 
ing conditions.  The  tendency  of  the  Government  of  the  United  States 
in  the  matter  of  quarantine,  as  administered  by  the  Public  Health  and 
Marine-Hospital  Service,  is  to  recognize  changed  commercial  condi- 
tions and  advances  in  knowledge  regarding  quarantinable  diseases.  It 
is  necessary  to  be  extremely  careful  not  to  become  negligent  or  to  re- 
lax in  vigilance,  but  there  are  certain  truths  which  are  coming  out 
constantly  that  enable  us  to  act  with  greater  intelligence  as  time  goes  on. 

I  will  mention  for  instance  the  matter  of  bubonic  plague.  We  re- 
gard now  an  individual  who  comes  to  a  quarantine  station  at  one  of 


FOURTH  INTERNATIONAL  SANITARY  CONFERENCE.  43 

our  domestic  ports  with  bubonic  plague  as  less  a  menace  than  a  rat  on 
the  vessel  which  brings  him  if  that  rat  is  infected  with  bubonic  plague. 
There  is  more  danger  of  the  conveyance  of  this  dread  disease  from 
one  country  to  another  through  the  rats  on  the  vessels  than  through 
individuals,  but  that  does  not  make  us  less  careful  with  regard  to  the 
individuals ;  it  makes  us  more  careful  with  regard  to  rats. 

At  the  proper  time  I  shall  have  some  further  remarks  to  make  upon 
the  necessity  for  extreme  caution  in  preventing  the  spread  of  bubonic 
plague  from  one  port  to  another  through  the  medium  of  rats  on 
vessels. 

With  regard  to  yellow  fever,  what  has  interested  us  the  last  two 
years,  particularly  the  past  season,  has  been  the  singularly  small 
amount  of  the  disease.  The  Western  Hemisphere  has  not  been  en- 
tirely free,  but  the  presence  of  the  disease  throughout  all  our  littoral 
has  been  markedly  less  than  in  any  other  year  in  a  great  number  of 
years,  and  I  do  not  hesitate  to  say  here,  that  I  believe  it  is  not  simply 
accident,  that  it  is  not  simply  an  off  year  in  yellow  fever,  as  we  used 
to  say,  but  that  it  is  attributable  to  preventive  measures  which  have 
been  taken.  It  is  true  that  sanitary  measures  in  a  great  many  of  the 
ports  of  the  American  Republics — the  ports  of  the  United  States  in- 
cluded— with  regard  to  yellow  fever  are  defective,  but  it  is  astonishing 
how  really  beneficial  sanitary  measures  directed  against  an  epidemic 
disease  are.  Even  if  they  are  incomplete  they  do  a  great  deal  of  good. 
Of  course,  we  should  make  them  as  perfect  as  possible,  but  the  great 
thing  is  to  have  our  minds  on  these  subjects  and  be  alive  to  them  at  all 
times,  and  especially  at  times  and  places  when  and  where  the  disease  is 
m.ost  apt  to  make  its  assault. 

But,  as  I  have  said  before  in  these  conventions,  I  think  we  have 
made  quarantine  about  as  good  as  it  can  be  made.  Ido  not  mean  to 
say  too  much — lay  too  much  stress  on  that,  but  I  will  say  we  have  got 
the  principles  of  quarantine  on  a  scientific  basis  and  their  application 
is  becoming  every  year  more  rational  and  more  reasonable. 

Vv^'ith  regard  to  the  sanitation  of  the  ports  of  the  United  States  I 
have  a  list  (see  Appendix,  page  187)  of  the  dififerent  cities  and 
the  work  which  has  been  going  on.  I  will  not  attempt  to  read  the 
prepared  record,  but  I  assume  that  I  shall  have  the  privilege  of  putting 
it  in  the  Transactions.  I  will  turn  it  over  to  the  Secretary  and  anybody 
can  read  it,  but  I  will  say  in  a  general  way  that  the  work  of  sanitation 
of  our  cities  is  constantly  going  on.  There  is  a  great  awakening  in 
the  United  States  with  regard  to  domestic  sanitation  and  sanitation  of 
cities,  and  most  of  the  ports  where  the  sewerage  and  the  water  supply 
have  been  defective  are  rapidly  supplying  themselves  with  good  sew- 
erage systems  and  good  water  supplies.  New  Orleans,  for  instance, 
has  about  completed  its  new  sewerage  system. 

With  regard  to  the  destruction  of  mosquitoes,  a  very  important  mat- 
ter, this  has  been  carried  on  in  dififerent  parts  of  the  United  States, 
effectively  in  some  parts,  and  without  very  much  energy  in  others.  It 
is  a  matter  which  the  National  Government  cannot  compel  the  State 
and  local  governments  to  act  upon.  But  the  National  Government 
exercises  its  influence  as  follows :  As  you  know,  every  State  of  the 
46  States  in  the  Union  has  a  State  Board  of  Health  or  State  Depart- 
ment of  Health.     Under  National  law  the   Surgeon-General  of  the 


44  FOURTH  INTERNATIONAL  SANITARY  CONFERENCE. 

Public  Health  and  Marine-Hospital  Service  is  required  to  call  a 
conference  annually  of  all  the  State  Boards  of  Health,  so  we  meet 
in  Washington  once  every  year  and  discuss  these  measures,  and  it  is 
then  that  tlie  Surgeon-General  can  bring  these  matters  to  the  attention 
of  the  different  heads  of  the  several  State  Health  Departments  and 
exercise  an  influence  in  bringing  about  these  local  sanitary  reforms. 
The  State  Boards  of  Health  in  the  United  States  are  fast  becoming 
most  admirable  and  effective  organizations.  It  is  the  policy  of  the 
National  Government  to  encourage  them  and  to  throw  the  work  of 
domestic  sanitation  upon  these  State  Boards  of  Health  while  they 
themselves  may  throw  it  upon  their  different  municipalities.  This  is 
the  manner  in  which  there  has  been  an  evolution  of  the  health  organi- 
zation of  the  United  States.  The  State  Governments  have  more  direct 
influence,  in  many  respects,  with  the  people,  with  the  municipalities, 
than  the  National  Government  could  have,  though  in  some  other  re- 
spects the  National  Government  has  more  influence.  In  times  of 
great  epidemics  or  when  there  is  danger  of  their  introduction  or  an 
appeal  is  made  to  the  National  Government  to  assist,  or  if  the  States 
do  not  take  the  proper  measures  themselves,  the  United  States  has  a 
right  anywhere  to  exercise  its  functions  in  the  suppression  of  the  dis- 
ease. But  sanitary  regulations  that  are  in  the  nature  of  police  regu- 
lations are,  in  the  construction  of  our  Constitution,  left  to  the  States. 
Otherwise  the  State  Governments  and  Municipal  Governments  would 
weakly  lean  upon  the  National  Government,  and  that  it  is  not  what  is 
desired. 

Now,  in  some  States,  as  New  Jersey,  New  York,  and  others  that  I 
might  mention,  the  warfare  against  mos'quitoes  has  been  very  vigor- 
ous and  very  successful,  and  malaria  has  been  diminished,  but  in  other 
places  where  they  should  pay  attention  to  it,  they  have  not  done  all 
they  should  do,  there  is  no  doubt  about  that,  but  we  are  making 
progress. 

I  am  making,  therefore,  what  may  be  termed  a  report  of  progress 
with  regard  to  these  matters,  and  by  the  time  the  next  Convention  is 
held  I  believe  I  will  be  able  to  report  a  great  deal  more  efficiency  with 
regard  to  this  important  measure. 

One  matter  that  I  think  might  prove  of  interest  to  the  delegates  is 
the  matter  of  vaccination  and  smallpox.  Smallpox  does  not  trouble 
us  as  it  used  to,  and  I  believe  this  is  largely  due  to  the  effectiveness  of 
modern  vaccine  virus  and  this  efficiency  is  due  to  a  National  law  which 
requires  that  all  establishments  that  prepare  vaccine  must  receive  a 
license  from  the  Secretary  of  the  Treasury  before  they  are  allowed 
to  sell  their  product  in  interstate  commerce ;  and  before  they  can  re- 
ceive that  license  their  establishments  must  be  inspected  by  the  Public 
Health  and  Marine-Hospital  Service  and  anything  wrong  connected 
with  the  establishment  itself,  with  the  plant,  or  with  the  method  of 
procedure,  must  be  corrected  before  the  license  is  granted. 

As  a  consequence,  the  vaccine  virus  in  the  United  States  is  of  a  very 
superior  grade,  and  whereas  only  a  few  years  ago  sore  arms  due  to 
local  infection  were  often  the  result  of  vaccination,  they  are  now  quite 
a  rarity — a  sore  arm  is  quite  rare.  So  we  feel  we  have  made  great 
progress  in  the  matter  of  the  suppression  of  smallpox.     The  cases  of 


FOURTH   INTERNATIONAL.  SANITARY  CONFERENCE.  45 

smallpox  reported  this  year  were  considerably  less  in  number  than  in 
the  previous  year. 

With  regard  to  trachoma,  we  have  always  had  that  upon  our  list 
of  diseases  which  must  be  excluded,  and  we  examine  very  carefully 
for  trachoma  all  arriving  immigrants.  We  examine  immigrants  at  a 
number  of  foreign  ports,  but  we  rely  upon  the  inspections  at  the 
domestic  port  for  keeping  out  trachoma. 

With  regard  to  the  free  distribution  of  quinine,  I  would  say  that  is 
a  measure  that  cannot  be  enforced  by  the  National  administration. 
The  States  might  do  it,  but  I  do  not  believe  that  is  necessary  in  the 
United  States ;  at  any  rate  I  do  not  recall  that  this  has  been  done  by 
any  State.  But  with  regard  to  the  free  importation  of  certain  material 
intended  to  prevent  the  spread  of  disease  by  mosquitoes,  such  as  mos- 
quito netting,  I  am  pleased  to  say  that  in  the  last  tariff  act  mosquito 
netting  was  either  put  on  the  free  list  or  it  was  very  materially  reduced 
so  as  to  cheapen  the  material  and  keep  it  within  a  reasonable  cost. 

I  do  not  feel  that  it  is  necessary  to  go  into  further  details.  I  be- 
lieve I  have  covered  in  a  general  way  the  requirements  of  the  after- 
noon. I  could  talk  a  long  while  upon  tuberculosis,  but  that  subject 
will  be  more  appropriately  considered  at  another  time.  So  with  these 
remarks  I  will  close  this  part  of  my  report. 

The  President.  As  I  have  to  absent  myself  for  a  few  moments, 
I  beg  Dr.  Roberts  to  take  the  Chair. 

The  President  Pro  Tem.,  Dr.  Roberts.  Do  any  of  the  Delegates 
wish  to  ask  any  data  in  regard  to  the  report  that  Dr.  Wyman  has  just 
read?  If  not,  following  the  order  established,  the  Delegate  from  the 
Mexican  United  States,  Dr.  Uiceaga,  has  the  floor. 

Dr.  Liceaga.  Gentlemen,  the  Mexican  Delegation  has  followed 
closely  this  point  of  the  program.  I  believe  that  this  was  the  subject 
of  my  first  report,  when  I  spoke  of  the  immigration  law,  which  com- 
prises many  of  the  matters  concerning  the  sanitation  of  ports,  dis- 
eases the  introduction  of  which  is  not  permitted,  etc.,  and  fol- 
lowing strictly  the  order  of  the  resolutions  of  previous  Conferences, 
one  by  one,  until  all  of  them  has  been  dealt  with.  Therefore,  what  is 
required  in  this  subject  of  the  program  has  already  been  covered. 
There  are  many  other  points  which  have  already  been  discussed,  and 
also  other  ones  in  regard  to  which  the  Mexican  commission  has  written 
and  printed  reports,  but  this  is  not  the  opportune  time  in  which  they 
should  be  presented.  Therefore,  the  delegation  will  submit  them  in 
detail  under  subjects  2,  3,  4,  5,  etc.,  of  the  program,  because,  as  I  have 
said,  they  are  all  in  writing  and  printed. 

The  President  Pro  Tem.,  Dr.  Roberts.  Do  any  of  the  Delegates 
wish  to  make  any  remarks  in  regard  to  what  the  Delegate  from  the 
Mexican  United  States  has  said?  If  not,  proceeding  with  the  reports, 
the  Delegate  from  the  United  States  of  Venezuela  has  the  floor. 

Dr.  Acosta.  Mr.  President,  this  is  really  the  first  time  that  Vene- 
zuela takes  an  active  part  in  these  Conferences,  although  in  1905 
Venezuela  signed  the  Sanitary  Convention  of  Washington.  For  that 
purpose  she  sent  as  her  delegate  her  diplomatic  agent  in  the  United 
States ;  therefore,  it  can  be  said  that  this  is  the  first  time  that  a 
Venezuelan  Delegation  takes  part  in  these  Conferences. 


46  FOURTH  INTERNATIONAL  SANITARY  CONFERENCE. 

What  Dr.  Liceaga  has  just  said  in  regard  to  his  report,  I  must  also 
say,  referring  to  the  lengthy  report  that  Dr.  Razetti  presented  yes- 
terday, as  it  contains  one  by  one,  and  with  careful  details,  all  the 
points  that  might  be  discussed  at  this  moment. 

However,  as  this  is  the  first  time  that  Venezuela  takes  part  in  these 
Conferences  and  as  it  was  not  really  obliged  to  fulfill  all  the  provis- 
ions of  the  Washington  Convention,  it  is  necessary  to  dwell  upon  cer- 
tain interesting  points.  The  organization  of  public  hygiene  in  Vene- 
zuela is  comparatively  recent,  because  only  in  April  last  was  the  com- 
mission of  public  hygiene  organized  in  the  manner  set  forth  in  our 
report,  it  being  composed  of  six  physicians,  one  engineer,  and  one  law- 
yer. The  committee  of  public  hygiene  made  it  its  first  duty  to  fight 
the  plague  by  all  possible  means ;  after  it  has  devoted  its  time  to  the 
carrying  out  of  measures  of  another  character ;  disinfection  apparatus 
has  been  ordered;  it  has  submitted  a  project  of  general  law  on  the 
protection  of  public  health,  copied  from  the  French  law  of  1902;  but 
naturally  those  are  projects  which  have  to  be  carried  out  in  the  future, 
because  one  of  the  greatest  difficulties  that  we  encounter  in  coun- 
tries as  poor  as  ours,  is  that  there  are  no  Rockefellers  there,  and  there- 
fore, we  have  to  provide  ourselves  first  with  the  necessary  means. 
One  of  the  greatest  obstacles  that  the  commission  of  public  hygiene 
in  Venezuela  has  encountered  in  carrying  out  its  plans,  has  been  the 
lack  of  the  necessary  means  and  the  indispensable  money  for  such 
projects  which  are  very  expensive,  most  costly  indeed,  such  as  the 
sanitation  of  ports,  construction  of  buildings,  etc.,  which  require 
millions  of  dollars.  Therefore  the  commission  of  public  hygiene  in 
Venezuela  has  tried  to  fight  the  plague  and  it  has  devoted  its  time 
mainly  to  public  health  in  all  respects. 

It  is  very  important  that  I  should  state  at  this  point  that  our  pres- 
ence in  this  Conference,  the  fact  that  Venezuela  should  have  sent  two 
prominent  officials  of  the  Commission  of  Public  Hygiene — the  Secre- 
tary, Dr.  Razetti,  and  the  President  of  the  said  Commission,  myself — 
proves  that  Venezuela  has  the  best  wishes  to  participate  in  the  activities 
of  progress  by  these  Sanitary  Conferences.  But  as  the  year  before  last 
wdien  the  first  epidemic  of  plague  broke  out,  the  Government  of  Vene- 
zuela, owing  to  reasons  which  it  is  not  necessary  to  state,  did  not  adopt 
the  proper  measures  nor  did  it  act  in  accordance  with  the  convention 
of  Washington,  a  fact  which  has  cost  the  country  serious  damages, 
and  of  this  we  have  a  practical  example  of  recent  date,  because  the 
delegation  of  Venezuela  which  came  in  an  immune  ship  from  a  port 
that  for  more  than  one  year  and  a  half  has  been  completely  healthy, 
was  subjected  to  quarantine  in  Colon.  In  this  way  the  Con- 
vention of  Washington  was  violated  and  I  want  to  so  state  here  in 
public. 

The  circumstances  leading  to  the  fact  that  the  plague  epidemic  in 
Venezuela  at  that  time  was  not  reported,  were  of  a  political  nature, 
tlie  knowledge  of  which  would  not  be  of  interest  to  the  Conference. 
What  is  interesting  to  know  is  that  the  present  Government  of  Vene- 
zuela has  determined,  as  our  presence  here  proves,  to  adhere  to  all  the 
provisions  of  the  Convention  of  Washington  and  to  be  in  the  greatest 
harmony  possible  with  all  the  other  nations. 


FOURTH  INTERNATIONAL  SANITARY  CONFERENCE.  47 

Therefore,  I  beg  the  Delegates  who  wish  further  data,  to  consult 
the  lengthy  annexes  that  we  have  accompanied  to  the  reports. 

The  President  Pro  Tem..  Dr.  Roberts.  The  Delegates  wishing 
to  ask  any  questions  of  the  representative  from  Venezuela,  in  regard 
to  his  remarks,  may  do  so. 

There  being  nobody  who  wishes  to  take  the  floor,  I  am  going  to  ask 
a  question  of  the  Delegate  from  Venezuela. 

As  I  understand,  when  the  bubonic  plague  broke  out  in  Venezuela, 
the  Government  did  not  report  it  on  account  of  political  reasons. 

Dr.  Acosta.  That  was  another  government  and  it  happened  two 
years  ago. 

The  President  Pro  Tem.,  Dr.  Roberts.  The  government  at  that 
time  did  not  report  the  plague  through  political  reasons.  I  would  like 
to  know  if  such  a  thing  could  happen  again  at  this  time. 

Dr.  Acosta.  At  present  the  Commission  of  Public  Hygiene  has  the 
duty  to  issue  a  daily  statement  so  that  the  Official  Gazette  may  pub- 
lish every  day  the  statistics  of  all  the  deaths  and  cases  of  transmissible 
diseases ;  and  every  physician  is  obliged  to  report  any  cases  coming 
under  their  observation,  and  by  this  means  the  Government  of  Cara- 
cas knows,  on  the  same  day,  the  cause  of  death  of  persons  within  the 
Federal  District,  as  well  as  the  infectious  disease  reported  by  the 
physician. 

As  we  committed  the  mistake  to  which  I  have  referred  and  which 
we  acknowledge,  it  so  happens  that  more  credit  is  given  to  the  news- 
paper men  than  to  the  agents  of  governments.  In  last  November  the 
following  took  place  in  Caracas :  The  delegates  are  well  aware  that 
there  are  certain  forms  of  plague  the  diagnosis  of  which  is  extremely 
difficult,  so  much  so  that  an  infectious  pneumonia  is  sometimes  mis- 
taken for  a  case  of  plague  of  the  pneumonic  form;  a  differential 
diagnosis  not  being  visible  without  the  use  of  the  microscope.  Well, 
then,  it  happened  that  one  of  these  cases  was  mistaken  for  plague, 
and,  as  there  exists  now  in  Venezuela  a  complicated  organization  as 
regards  the  public  health  service,  the  physician  reported  the  case  as  a 
suspicious  one,  and  an  agent  of  the  New  York  health  service  reported  it 
as  a  case  of  plague,  and  that  paper  immediately  gave  out  the  news  that 
there  was  bubonic  plague  in  Venezuela.  It  thus  seems  that  the  news- 
papers are  given  more  credit  than  the  governments. 

(At  this  point  the  President  took  his  seat  again.) 

Dr.  Wyman.  Mr.  President :  As  the  last  speaker  was  discussing 
the  subject  I  have  been  informed  of  what  he  was  saying.  Although 
I  do  not  understand  the  Spanish  language,  my  colleague.  Dr.  Amesse, 
has  told  me  the  purport  of  it,  and  I  wish  to  say  here  that  while 
Venezuela  formerly  was  the  source  of  the  gravest  concern  to  the 
United  States,  and  if  it  had  not  been  at  one  time  for  the  almost 
complete  cessation  of  commerce  between  the  ports  of  Venezuela 
and  the  United  States,  I  do  not  know  what  recommendation  it  might 
have  been  necessary  for  the  sanitary  authorities  of  the  United  States 
to  make.  At  one  time  when  the  bubonic  plague  was  first  announced 
in  Venezuela  we  endeavored  to  have  an  officer  in  the  port  of  La  Guaira 
to  look  after  the  safety  of  vessels,  cargoes  and  persons  bound  for  the 
United  States  in  accordance  with  our  law,  but  we  were  unable  for  a 
long  while  to  get  anyone  there.    There  was  objection,  and  in  the  mean- 


48  FOURTH  INTERNATIONAL  SANITARY  CONFERENCE. 

time  commerce  became  so  small  that  the  matter  was  allovv-ed  to  rest 
for  the  time  being.  But  when  this  new  regime  came  in  I  want  to  say 
that  they  expressed  the  greatest  willingness  to  have  a  representative 
of  our  government  in  their  principal  seaport.  They  invited  us  to  send 
a  man  there,  and  I  take  this  occasion  to  express  my  appreciation  of 
that  action. 

As  you  know,  we  have  in  the  port  of  La  Guaira  now  a  sanitary 
expert  named  Dr.  Kellogg,  who  is  there  to  look  after  the  safety  of 
ships  bound  for  the  United  States,  just  as  we  have  them  in  all  other 
ports  in  accordance  with  our  law  where  they  have  an  infectious  dis- 
ease, and  the  courtesy  that  has  been  extended  to  that  officer  I  want  to 
express  my  appreciation  for  now. 

But,  whatever  may  have  been  the  difficulties  in  Venezuela  in  the 
past,  I  feel  that  with  the  presence  of  these  two  Delegates  here  to-day  we 
can  feel  sure  that  those  difficulties  are  over  and  there  will  now  be  an 
intelligent  and  effective  regime.  I  think  that  this  is  the  feeling  which 
we  have  in  our  Sanitary  Bureau  at  Washington  at  the  present  time. 
We  feel  that  they  will  not  spare  any  expense  in  preventing  the  escape 
of  bubonic  plague  or  any  other  contagious  disease  to  our  ports. 

(Dr.  A^asquez  repeated  the  remarks  of  Surgeon-General  Wyman  in 
the  Spanish  language.) 

Dr.  Razetti.  I  believe  it  is  necessary  to  give  a  few  details  as  to 
what  happened  at  the  beginning  with  the  plague  in  Venezuela.  Gen- 
eral Castro,  who  by  politics  ruled  the  country  despotically,  did  not 
see  fit  to  notify  the  friendly  nations,  and  much  less  those  that  had 
subscribed  the  Convention  of  Washington,  that  there  was  plague  in 
La  Guaira ;  although  he  did  take  the  necessary  precaution,  in  such  a 
way,  that  by  an  executive  decree  La  Guaira  was  closed  and  communi- 
cated from  the  capital,  and  it  can  be  said  that  even  more  precautions 
than  those  prescribed  by  the  Convention  of  Washington  were  taken, 
although  without  declaring  that  there  was  an  epidemic  of  plague,  in 
spite  of  the  fact  that  everybody  knew  that  it  did  exist. 

As  to  the  remarks  of  Dr.  Wyman,  I  have  the  honor,  in  the  name  of 
the  Delegation  of  Venezuela,  to  thank  him  most  sincerely  for  the 
favorable  statements  that  he  has  made  concerning  our  present  Gov- 
ernment. 

The  President.  After  the  explanations  made  by  the  Delegation 
of  the  United  States  of  Venezuela,  and  of  the  remarks  by  the  Surgeon- 
General  of  the  Public  Health  and  Marine  Hospital  Service  of  the 
LTnited  States.  Dr.  Wyman,  which  statements  are  an  evidence  of  the 
great  change  in  the  sanitary  conditions  of  the  United  States  of  Vene- 
zuela, I  have  the  honor  to  move  that  we  send  our  congratulations  to 
the  new  Venezuelan  Government  for  the  measures  that  it  is  carrying 
out  on  behalf  of  public  health. 

(A  vote  was  taken  on  the  above  motion,  which  was  unanimously 
approved.) 

The  President.     The  Delegate  from  Guatemala  has  the  floor. 

Dr.  Toledo.  Mr.  President,  I  am  going  to  repeat  what  I  said  this 
morning  in  my  report,  to  wit :  That  I  have  absolutely  no  data  as  to 
the  measures  taken  by  the  Government  of  Guatemala  two  years  hence. 
Therefore.  I  request  that  I  be  relieved  from  the  duty  of  making  a  re- 
port on  this  subject. 


FOURTH  INTERNATIONy\L  SANITARY  CONFERENCE.  49 

(The  Secretary,  Dr.  Razetti,  read  a  note  from  the  Department  of 
Foreign  Affairs  stating  that  seats  had  been  sent,  to  be  distributed 
among  the  physicians  of  Costa  Rica  for  the  Inaugural  session.) 

Dr.  Soto,  President  of  the  Medical  Faculty  of  Costa  Rica. 
With  regard  to  the  subject  referred  to  in  the  note  from  the  Secretary 
for  Foreign  Affairs,  I  have  the  honor  to  state  that  in  due  time  I  re- 
ceived the  seats  and  that  I  immediately  had  them  distributed  among 
the  most  prominent  physicians  of  this  city  and  it  was  so  done. 

At  the  same  time  I  must  say  that  only  eighteen  seats  were  sent  and 
not  twenty,  as  the  note  says. 

The  President.  Proceeding  with  the  Program,  the  Delegate  from 
Honduras  has  the  floor. 

Dr.  Vasouez.  Mr.  President,  in  the  report  that  1  had  the  honor  to 
present  I  said  something  as  to  what  the  Government  of  Honduras 
has  done  in  compliance  with  the  resolutions  of  the  previous. Confer- 
ences. Although  the  Government  of  Honduras  has  every  desire  to 
comply  with  the  provisions  of  any  of  these  Conferences,  it  is  handi- 
capped by  the  insurmountable  difficulty  of  the  lack  of  means.  Our 
poor  Honduras  is  one  of  the  poorest  countries  of  America,  and  it  is 
very  difficult  for  her  to  put  into  practice  what  for  other  nations  is 
feasible,  as  is  the  case  with  Panama,  which  has  the  efficient  help  of 
the  American  Government,  Cuba,  and  the  United  States,  which  are 
really  wealthy  countries. 

However,  the  Government  of  General  Davila  does  its  best  to  fulfill 
the  mandates  of  these  Conferences. 

At  present  there  are  being  carried  out  all  the  sanitary  laws  and  regu- 
lations enacted  since  the  Third  Conference. 

The  Convention  recommends  vaccination,  and  this  recommendation 
has  many  years  since  been  a  law  in  the  Republic.  Vaccination  and  re- 
vaccination  are  compulsory.  The  benefits  of  these  measures  were  evi- 
denced when  last  year  the  country  was  invaded  by  an  epidemic  of 
smallpox,  which  made  no  ravages ;  the  death  rate  was  very  small  as  a 
result  of  vaccination.  The  same  lack  of  resources  prevented  the 
Government  from  placing  on  the  free  list  quinine  salts,  wire  screens, 
crude  petroleum,  etc.,  but  the  Government  has  always  distributed 
quinine  among  needy  persons  in  the  ports  of  the  Atlantic  where 
malaria  is  more  prevalent.  The  most  active  propaganda  is  being  carried 
on  by  the  Government  for  spreading  among  the  people  the  knowledge 
of  prophylaxis,  and  it  has  made  it  known  to  the  ignorant  masses  that 
malaria  is  transmitted  by  the  bite  of  the  anopheles  mosquito,  and  the 
people  are  already  beginning  to  know  how  to  distinguish  this  kind 
of  mosquito  from  the  others.  In  the  ports  of  Amapala  and  Puerto 
Cortes  wire  screens  are  placed  in  the  windows  and  doors  to  avoid 
mosquitoes. 

The  railroad  of  the  Republic,  in  the  short  section  between  Puerto 
Cortes  and  Pimienta,  uses  no  carpets  nor  cvirtains ;  cuspidors  are  pro- 
fusely distributed  in  all  the  cars  and  it  is  prohibited  to  expectorate 
on  the  floors.  In  the  principal  cities  of  the  Republic,  in  public  places, 
offices,  cantines,  hotels,  and  all  places  to  which  the  public  has  access 
are  posters  stating  that  for  the  prevention  of  the  spread  of  tuber- 
culosis it  is  prohibited  to  expectorate  on  the  floor.  This  is  what  the 
Government  of  Honduras  has  done  in  compliance  with  the  provisions 


50  FOURTH    INTERNATIONAL   SANITARY   CONFERENCE. 

of  the  last  Convention  of  Washington.  As  to  the  other  Conferences 
the  Government  has  paid  httle  attention.  It  has  only  carried  out  the 
provisions  of  the  Third  Sanitary  Convention  of  Mexico,  held  two 
years  ago. 

The  President.  The  Delegate  from  Panama,  Dr.  Porras,  has  the 
floor. 

Dr.  Porras.  Mr.  President,  the  report  that  I  had  the  honor  of  read- 
ing yesterday,  under  Chapter  2nd,  set  forth  the  manner  in  which  the 
resolutions  adopted  in  previous  Conferences  have  been  carried  out  in 
my  country.  However,  I  am  going  to  report  to  the  Honorable  Con- 
ference the  general  and  special  measures  adopted  in  fulfillment  of  the 
resolutions  passed  by  the  Third  International  Sanitary  Conference, 
held  in  Mexico  in  December,  1907. 

The  most  important  of  these  measures  has  consisted  in  intrusting  to 
an  American  Board  of  Health  everything  relating  to  public  health  and 
hygiene.  The  Republic  of  Panama,  founded  only  six  years  ago,  with- 
out traditions,  schools,  roads,  etc.,  found  it  necessary  to  intrust  the 
health  of  the  country  to  the  expert  American  physicians.  It  also  did 
so  for  the  purpose  of  avoiding  the  considerations  that  in  small  coun- 
tries people  owe  to  each  other. 

This  Board  has  complied  with  all  the  resolutions  adopted  in  previous 
Conferences,  carrying  out  all  their  provisions. 

When  the  American  Board  of  Health  considered  that  the  Republic 
of  Panama  was  already  of  age  and  that  it  was  capable  of  looking  after 
public  hygiene,  it  intrusted  to  the  Panaman  Government  part  of  that 
control,  that  relating  to  the  cleaning  of  cities,  and  for  the  last  two 
years  the  Republic  of  Panama  has  looked  after  that  part  of  hygiene. 

However,  the  codification  of  all  the  sanitary  laws  and  measures  is 
not  complete.  Vaccination  against  smallpox  is  absolutely  compulsory. 
Quinine  salts,  wire  netting,  mosquito  nets,  have  been  put  in  the  free 
list.  There  is  also  a  more  active  propaganda  for  spreading  the  knowl- 
edge of  etiology,  prophylaxis,  and  treatment  of  malaria,  by  means  of 
public  lectures  held  in  the  Ancon  Hospital,  which  were  attended  by  a 
great  number  of  persons ;  and  instructive  circulars  have  been  dis- 
tributed, regarding  the  most  constant  of  diseases  in  Panama  and  the 
Canal  Zone — malaria. 

The  death  rate  caused  by  malaria  is  specified  in  the  bills  of  health 
that  are  issued  in  our  ports.  This  disease  has  almost  disap- 
peared from  the  ports  of  Panama  and  Colon,  because  among  the 
measures  adopted  against  it  are  the  building  of  sewers,  the  drainage 
of  swamps  and  of  all  the  wells  in  those  cities ;  formerly,  in  Panama, 
the  only  source  of  water  supply  were  the  wells,  existing  since  the 
colonial  times,  whereas  now  those  cities  are  provided  with  excellent 
aqueducts. 

Immigrants  suffering  of  trachoma,  beri-beri,  leprosy,  etc.,  are  not 
admitted  in  our  territory.  The  use  of  carpets  and  curtains  is  also 
avoided;  railroad  cars,  and  steamer  cabins,  especially  those  on  ships 
going  to  and  from  the  United  States,  are  disinfected  periodically.  In 
those  cars  and  cabins  are  conspicuously  posted  labels  prohibiting  ex- 
pectoration. 

This  is,  gentlemen,  more  or  less  the  detail  of  the  manner  in  which 


FOURTH   INTERNATIONAL  SANITARY  CONFERENCE.  51 

the  resolutions  of  the  Third  Sanitary  Convention  of  Mexico  have  been 
carried  out  in  my  country. 

The  President.  I  would  request  Dr.  Porras  to  tell  us  if  those 
measures  to  which  he  alludes  are  carried  out  throughout  the  Republic, 
because  I  have  noticed  that  in  his  report  he  refers  to  the  Canal  Zone, 
which  is  under  the  supervision  of  the  American  Board  of  Health ;  for 
that  reason  I  would  like  to  know  if  the  said  measures  have  been  car- 
ried out  in  what  is  the  Republic  of  Panama  proper. 

Dr.  Porras.  In  my  country  there  is  a  general  board  of  health,  and 
that  board  has  physicians  in  the  provinces  of  the  Republic  who  fulfill 
religiously  all  the  orders  of  the  central  board  of  public  health. 

I  should  also  add  in  this  respect,  that  in  my  country,  the  interior 
towns,  which  were  built  by  the  Spaniards  on  the  other  side  of  the  Cor- 
dillera towards  the  Pacific  slope,  evidently  for  the  purpose  of  safe- 
guarding them  against  the  attacks  of  buccaneers  and  pirates,  have  a 
most  excellent  climate  and  are  comparatively  healthier  than  those  on 
the  Atlantic  Zone. 

The  President.  Is  the  Central  Board  composed  of  Panaman 
physicians  ? 

Dr.  Porras.  Yes,  Mr.  President,  there  are  on  that  Board  Pana- 
man physicians,  but  at  the  head  of  it  is  the  illustrious  physician.  Dr. 
W.  G.  Gorges.     The  Boards  of  Health  have  Panaman  physicians. 

Dr.  Rojas.  Mr.  President,  Messrs.  Delegates :  In  compliance  with 
the  subject  of  the  program  in  regard  to  the  fulfillment  given  by  the 
different  countries  to  the  resolutions  adopted  in  previous  conferences, 
the  delegation  of  Costa  Rica  has  prepared  a  small  report,  which  I  am 
going  to  have  the  honor  to  read.     (See  Appendix,  page  133.) 

The  President.  Following  the  order  of  the  program  we  shall  now 
proceed  with  the  discussion  of  the  reports  regarding  the  sanitary  con- 
ditions of  ports  and  measures  that  may  be  submitted  for  the  better- 
ment of  such  conditions.  I  request  the  Delegates  having  papers  on  this 
subject  to  present  them. 

Dr.  Wyman.  Mr.  President,  I  suppose  it  is  in  order  to  comment, 
as  I  propose  to  comment,  on  one  matter,  and  that  is  that  at  some 
time  during  our  proceedings  we  should  bring  up  the  matter  of  a  port's 
■self-protection.  It  is  very  necessary  that  every  port  should  have  a 
quarantine  station.  I  do  not  believe  that  that  fact  is  sufficiently  un- 
derstood. The  quarantine  station  is  a  necessity  for  a  port,  not  only 
for  the  safety  of  that  port  as  against  other  ports  that  may  be  in- 
fected, but  also  for  its  commerce.  When  a  vessel  comes  to  a  port 
with  infectious  disease  aboard  there  should  be  provision  made  for 
taking  care  of  that  infection,  for  taking  the  passenger  off  and  isolating 
him  on  shore  and  also  detaining  under  observation  for  a  period 
equal  to  the  incubation  period  of  the  disease  all  those  who  have  been 
exposed ;  then  the  vessel  should  be  disinfected,  and  when  that  is  done 
the  vessel  may  go  to  the  port  with  safety.  Therefore  a  well-equipped 
quarantine  station  is  a  necessity  for  the  facilitating  of  the  commerce 
of  the  port.  In  the  old  Venetian  days  these  vessels  used  to  lie  out  for 
forty  days  and  nothing  was  done.  What  kind  of  commerce  was  that? 
In  modern  times  the  vessel  need  not  be  held.  A  new  crew  is  provided 
and  the  vessel  is  allowed  to  go  to  the  dock  and  discharge  its  cargo 
and    receive   cargo    for   another   port.     Modern    commerce    demands- 


52  FOURTH    INTERNATIONAL   SANITARY    CONFERENCE. 

that.  I  believe  that  there  are  some  ports  in  our  Western  Hemis- 
phere that  are  not  properly  equipped  and  they  ought  to  be. 
It  is  a  matter  for  the  benefit  of  the  port  commercially,  and  it  is  a 
matter  of  humanity.  I  have  known  of  cases  where  vessels  have 
sought  to  enter  a  port,  with  infectious  disease  aboard,  and  because 
that  port  had  no  means  of  taking  care  of  the  patients  sick  with  con- 
tagious diseases  they  have  been  waved  ofY  to  some  other  port  and 
waved  off  from  that  port  to  some  other  port  still  further  along,  and 
all  this  time  the  patients  on  board  were  not  properly  treated  and  the 
other  people  were  held  on  board  exposed  to  the  infection  and  liable 
to  get  it.  So  that  if  there  is  any  port  in  this  Western  Hemisphere  not 
provided  with  a  quarantine  station,  some  means  to  take  care  of  a  sick 
vessel  as  well  as  sick  individual,  we  ought  to  lay  stress  on  that  subject 
and  it  might  be  the  subject  of  a  resolution. 

The  remarks  of  Surgeon-General  Wyman  were  translated  and  re- 
peated to  the  Conference  in  Spanish. 

The  President,  The  subject  under  discussion  is  one  of  the  most 
important  before  the  Conference.  I  am  entirely  in  accord  with  the 
remarks  of  Dr.  Wyman.  It  seems  to  me  that  it  is  a  crime  against 
civilization  and  humanity  to  deny  entrance  to  a  vessel  coming  from  an 
infected  port,  or  having  cases  on  board,  simply  because  the  country 
where  such  a  thing  happens  either  has  refused  to  comply  with  the  prin- 
ciples of  maritime  hygiene,  or  has  not  properly  developed  the  humani- 
tarian feeling  that  it  should  have. 

Given  present  conditions  of  civilization  and  the  progresses  of  hygiene, 
I  believe  that  such  a  thing  should  no  longer  happen  in  our  continent, 
and  that  we  should  exert  our  best  efforts  to  overcome  this  difficulty. 
I  believe  that  we  should  persist  in  persuading  our  respective  govern- 
ments to  adopt  the  establishment  of  quarantine  stations  properly 
equipped  so  that  they  may  be  able  to  do  the  service  required  of  them 
by  public  hygiene.  Without  such  quarantine  stations,  not  only  are  hu- 
man beings — those  who  have  no  means  to  cure  themselves  of  diseases 
which  might  be  cured  if  there  were  lazarettos — mistreated,  but  also 
the  country  is  subjected  to  evil  conditions  which  are  detrimental  to 
commercial  interests. 

Therefore,  I  request  all  the  Delegates  to  bear  this  point  well  in  mind 
and  to  express  their  opinions  so  that  before  we  adjourn  this  session 
we  may  come  to  an  agreement  and  propose  a  resolution  along  the  lines 
suggested  by  Dr.  Wyman,  to  resolve  this  subject  and  to  exercise  all 
possible  influence  in  order  that  our  governments  shall  comply  with 
that  resolution  and  that  it  may  be  not  only  written  but  also  realized. 

Dr.  Liceaga.  The  idea  expressed  by  Dr.  Wyman  and  corroborated 
by  the  President  of  the  Conference  is  an  undisputed  fact.  It  is  abso- 
lutely necessary  that  there  should  be  established  in  all  the  ports  sani- 
tary and  quarantine  stations,  but  on  many  occasions  it  has  not  been 
possible  to  carry  out  in  all  ports  the  resolutions  adopted  by  previous 
Conferences,  because  the  financial  conditions  are  not  the  same  in  all 
countries.  For  this  reason,  experience  has  solved  the  problem  in  this 
manner.  There  are  ports  which  are  especially  assigned  to  admission  of 
vessels  carrying  suspicious  or  confirmed  cases  of  transmissible  dis- 
eases. If  each  nation  would  establish  such  ports,  the  question  would 
be  simplified ;  of  course,  the  ideal  thing  would  be  that  all  the  ports 


FOURTH   INTERNATIONAL  SANITARY  CONFERENCE.  53 

should  have  the  necessary  conditions ;  but  as  it  is  not  the  spirit  of  the 
conventions  to  accomphsh  that  ideal  at  once,  because  such  a  thing 
would  not  be  within  the  possibilities  of  the  majority  of  the  nations, 
but  to  achieve  it  in  so  far  as  possible,  I  hope  the  Convention  will 
deem  it  wise  to  provide  that  the  resolutions  be  couched  in  these 
terms:  "It  is  to  be  desired  that  all  the  ports  of  each  and  every  nation 
on  the  American  Continent  should  have  a  sanitary  station  and  quar- 
antine station ;  and  that  wherever  the  establishment  of  such  stations 
be  not  practicable,  and  pending  the  establishment  of  such  stations,  a 
port  be  assigned  on  the  coast  of  each  country  which  may  be  immedi- 
ately fitted  with  all  the  sanitary  requirements."  Oftentimes,  when  one 
thinks  of  great  undertakings,  what  should  be  done  is  left  undone,  be- 
cause, as  the  Spanish  proverb  says,  "The  best  thing  is  the  enemy  of 
the  good  thing."  When  we  say  sanitary  station,  or  lazaretto,  we  think 
immediately  of  a  large  establishment  with  capacity  for  thousands  of 
passengers,  like  the  one  in  the  port  of  New  York,  and  then  figure  that 
the  difficulties  are  absolutely  insurmountable.  How  could  the  small 
nations  build  a  quarantine  station  like  that  of  New  York?  It  would 
be  impossible. 

No;  let  us  put  the  question  on  a  feasible  basis,  and  such  a  basis  de- 
pends on  the  manner  of  looking  at  the  question.  If,  as  I  said  before, 
we  try  to  make  a  work  like  that  they  have  been  carrying  out  for  con- 
secutive years  in  New  York,  we  would  not  be  able  to  do  it;  but  if  we 
confine  ourselves  to  the  simplest  that  should  be  had,  then  our  ports 
could  be  provided  with  a  sanitary  station. 

The  idea  is  this.  I  am  going  to  express  it  because  we  have  carried 
it  out  in  Mexico  on  the  occasion  of  the  campaign  against  yellow  fever. 
At  most,  one  or  two  cases  may  occur  on  board  of  any  vessel,  because 
we  cannot  expect  that  infection  should  take  place  in  the  manner  of 
the  middle  ages,  when  it  used  to  happen  that  all  the  men  in  a  ship 
would  fall  sick.  Nowadays  such  a  thing  does  not  happen ;  those  one 
or  two  cases  may  be  isolated  in  a  lazaretto  equipped  in  the  simplest 
way,  that  is  to  say,  an  ordinary  house,  a  wooden  barrack,  or  a  private 
dwelling  with  about  three  rooms  could  be  converted  into  a  sanitary 
station,  it  being  enough  for  that  purpose  to  paint  one  of  the  rooms, 
pave  it,  disinfect  it,  and  put  it  in  a  fit  sanitary  condition  for  the  isola- 
tion of  the  patient.  If  there  be  a  case  of  yellow  fever,  sulphur  is 
burned  to  drive  away  mosquitoes,  the  windows  and  doors  are  screened 
with  wire  gauze,  etc.  Not  even  the  smallest  town  would  be  lack- 
ing in  the  necessary  materials  for  screening  doors  and  windows.  An- 
other room  may  be  fitted  for  the  watchman  or  nurse,  another  for  the 
kitchen.  Such  a  lazaretto  could  be  improvised  anywhere.  A  sanitary 
station  properly  equipped  would  be  more  difficult. 

I  have  made  this  interlude  for  the  purpose  of  showing  that  when 
there  is  good  will  to  follow  the  basis  of  a  principle,  and  not  its  details, 
one  can  succeed  in  gradually  carrying  it  out.  A  sanitary  station  fitted 
only  with  the  most  essential  requirements  can  be  had  anywhere.  Sani- 
tary stations  equipped  as  they  should  definitely  be  can  only  be  acquired 
by  the  lapse  of  time  and  by  means  of  large  resources. 

I  also  want  to  point  out  that  perhaps  it  would  be  convenient  to 
assign  in  each  nation  a  port,  or  ports,  in  which  infected  ships  could 
come  in ;  then  there  would  be  no  difficulty.     Therefore,  I  move  that 


54  FOURTH    INTERNATIONAL   SANITARY   CONFERENCE. 

the  proposition  of  Dr.  Wyman,  seconded  by  the  President,  be  ac- 
cepted, but  expressed  in  these  terms :  "That  while  all  the  ports  of 
the  American  nations  are  not  provided  with  permanent  sanitary  sta- 
tions, the  principal  ports,  or  those  having  the  largest  traffic  in  each 
nation,  be  fitted  with  sanitary  stations,  and  that  in  case  of  necessity 
such  sanitary  stations  be  improvised  in  any  port." 

Dr.  Soto.  For  the  purpose  of  carrying  out  so  good  an  idea  as  that 
of  establishing  quarantine  stations  in  the  majority  of  ports  I  would  like 
to  propose  the  following  idea :  There  being  a  committee  charged  with 
the  study  of  this  project,  I  move  that  the  President  refer  this  matter 
to  the  Committee  on  the  Sanitation  of  Ports  so  that  it  may  prepare  a 
project  to  be  by  it  submitted  and  discussed  in  detail  by  the  Conference 
as  soon  as  possible.  I  believe  that  this  is  the  most  practicable  way  of 
carrying  out  that  idea. 

Dr.  Roberts.  I  take  the  floor  to  second  the  statements  made 
by  Dr.  Liceaga.  Undoubtedly  the  best  thing  would  be  that  all  the 
ports  of  a  nation  should  be  fitted  to  receive  passengers  suffering  from 
transmissible  diseases,  but  there  are  many  ports  in  all  the  nations  of 
the  world,  beginning  with  the  United  States,  whose  traffic  is  so  small 
that  it  does  not  warrant  the  establishment  of  sanitary  stations  fully 
equipped,  in  which  case,  as  Dr.  Liceaga  says,  small  hospitals  might  be 
fitted  in  those  ports  for  the  treatment  of  infectious  cases ;  these  small 
hospitals  would  answer  the  purpose.  I  also  want  to  state  that  in  many 
cases,  and  especially  as  regards  yellow  fever,  even  the  regulation  ele- 
ments furnished  by  the  ship  are  sufficient  for  the  isolation  of  the 
patient  preventing  the  spread  of  the  disease  and  without  detriment  to 
the  operation  of  the  vessel.  In  the  ports  of  Cuba  I  have  very  often 
received  vessels  with  cases  of  yellow  fever  on  board,  and  without  any 
elements  other  than  those  provided  by  the  ships,  the  patients  have  been 
completely  isolated  and  public  health  safeguarded.  A  little  sulphur,  a 
kettle,  and  a  piece  of  wire  gauze  or  mosquito  net,  or  simply  a  sheet, 
are  sufficient  for  disinfection  of  a  cabin ;  the  complete  isolation  of  a 
patient  and  the  disinfection  of  the  rest  of  the  vessel,  and  thus  the 
patient  may  remain  on  board  without  any  danger  of  spreading  the 
disease.  This  means  that  when  one  wants  to  do  things,  as  Dr.  Liceaga 
says,  measures  are  improvised,  and  it  is  not  very  expensive  to  treat  a 
patient  and  to  safeguard  public  health. 

Dr.  Liceaga.  What  Dr.  Roberts  has  just  said  reminds  me  of  what 
we  used  to  do.  Our  campaign  against  yellow  fever  was  successful 
because  we  improvised  lazarettos  anywhere  we  chose.  Among  the 
means  that  we  had  for  this  purpose  was  the  building  of  tents,  which 
could  be  put  up  immediately ;  they  were  four  meters  square  and  three 
and  a  half  meters  high.  They  were  made  of  canvas  and  provided  with 
doors  and  windows  of  wire  gauze.  These  tents  were  easily  trans- 
ported. 

The  President.  I  beg  to  point  out  that  we  were  discussing  the 
proposition  of  Dr.  Wyman,  on  the  detailed  discussion  of  which  we 
shall  enter  later  on ;  the  question  to  be  decided  now  is  whether  or  not 
we  shall  accept  Dr.  Soto's  proposition,  to  refer  the  project  to  a  com- 
mittee, which  shall  report  thereon. 

I  believe  that  the  idea  of  Dr.  Wyman  does  not  call  for  first-class 
quarantine  stations  in  all  ports ;  such  a  thing  should  be  in  accord  with 


FOURTH  INTERNATIONAL  SANITARY  CONFERENCE.  55 

the  necessity  of  each  place  and  with  the  resources  of  the  respective 
countries. 

As  regards  the  point  raised  by  Dr.  Liceaga,  as  to  the  advisabihty  of 
each  country  selecting  a  port  for  receiving  vessels  from  infected  ports, 
and  fitting  it  for  the  treatment  of  infectious  diseases,  I  beg  to  point 
out  that,  as  a  general  rule,  in  America  the  Republics  are  small  and  have 
but  one  port  on  the  Atlantic  and  another  on  the  Pacific,  so  that  we 
would  only  have  to  equip  those  ports,  they  being  the  only  ones  of  entry. 

Wherever  there  is  commerce  and  movement  of  passengers  the  gov- 
ernments should  have  quarantine  stations,  equipped  within  the  meas- 
ure of  their  resources,  where  passengers  arriving  with  infectious  dis- 
eases may  be  treated.     That  is  the  point  referred  to  by  Dr.  Wyman. 

Far  be  it  from  our  minds  to  contemplate  the  building  here  of  a 
quarantine  station  like  that  of  New  York  or  Vera  Cruz ;  but  it  is  our 
duty,  as  it  is  also  the  duty  of  the  other  Republics  here  represented,  to 
build  such  stations  as  their  resources  will  permit. 

I  make  this  remark  merely  for  the  purpose  of  putting  the  discussion 
in  the  right  track,  so  that  no  details  shall  be  discussed  before  voting 
on  the  motion  of  Dr.  Soto. 

Dr.  Soto  repeated  his  motion  at  the  request  of  the  President. 

Dr.  Amesse.  Mr.  President,  there  was  one  point  brought  out  by 
the  Delegate  from  Cuba  that  might  need  clearing  up.  He  expressed 
the  opinion  that  the  United  States  was  not  equipped  with  complete 
quarantine  stations  at  all  ports.  That  is  true  in  a  measure.  We  have 
not  great  quarantine  stations  at  every  single  small  port,  but  we  have 
inspection  stations  at  those  ports  within  easy  distance  of  great  quaran- 
tine stations,  where  if  a  steamer  comes  in  it  is  promptly  boarded  by  an 
officer  of  the  Public  Health  and  Marine-PIospital  Service,  who  gives 
his  opinion  and  advice  as  to  the  treatment  of  the  patient  aboard  if 
necessary  and  then  the  vessel  is  remanded  to  the  nearest  quarantine 
station.  In  the  case  of  sailing  vessels  the  agents  are  notified  and  a 
tug  or  special  steamer  can  be  secured  to  tow  that  vessel  so  that  no 
time  is  lost.  I  think  that  might  be  adopted  in  other  countries,  as  in 
Cuba.  In  Cuba,  where  I  am  stationed,  I  think  there  are  four  quar- 
antine stations  and  a  number  of  ports  where  small  inspection  stations 
are  conducted. 

Dr.  von  Ezdorf.  I  have  been  in  charge  of  the  New  Orleans  Quar- 
antine Station  for  the  past  three  years,  where  all  cases  arriving  on 
vessels  with  fever  are  held  at  the  quarantine  station  for  observation. 
In  this  way  we  have  discovered  many  cases  of  infectious  diseases  not 
quarantinable,  and  have  thus  given  the  seaport  of  New  Orleans  pro- 
tection against  foreign  infection,  that  is,  the  admission  of  a  possible 
new  focus  of  infectious  disease  was  eliminated. 

I  have  incorporated  a  good  deal  of  the  principles  of  procedure  at  a 
quarantine  station  in  a  paper  which  I  wish  to  include  in  the  reports  of 
the  American  Delegation ;  in  it  I  also  discuss  the  foreign  quarantine 
measures  adopted  at  foreign  ports.  During  the  period  from  April  1, 
1907,  to  December  1,  1909,  there  were  removed  to  the  New  Orleans 
Quarantine  Station  Hospital  395  persons  for  observation.  None  of 
these  presented  a  quarantinable  disease.  The  following  is  a  partial 
list  of  the  diseases  treated:  Malaria,  112  cases,  of  which  54  were  of 
the  aestivo  autumnal  variety.     The    large    majority    of    the    cases    of 


56  l-OURTH    INTERNATIONAL   SANITARY    CONFERENCE. 

malarial  fever  were  confirmed  miscroscopically.  Typhoid  fever,  29 
cases;  tuberculosis,  11  cases;  beri-beri,  1  case;  mumps,  1  case;  general 
diseases,  241  cases.  The  vessel,  in  the  majority  of  instances,  was  not 
detained,  only  the  sick  individual  was  held. 

During  the  past  fiscal  year,  July  1,  1908,  to  July  1,  1909,  the  follow- 
ing is  a  list  of  diseases  in  persons  passed  on  vessels,  that  is  cases  not 
detained  for  observation:  Typhoid  fever,  6  cases;  malaria  (con- 
.firmed  microscopically),  19  cases;  tuberculosis,  6  cases;  pneumonia,  3 
-cases ;  dysentery,  1  case ;  impetigo  contagiosa,  1  case ;  general  diseases, 
35  cases;  scarlet  fever  (from  domestic  port),  1  case. 

In  our  quarantine  regulations  we  have  this  regulation :  "When 
a  vessel  arriving  at  quarantine  has  on  board  any  of  the  communicable 
but  non-quarantinable  diseases,  the  quarantine  officer  shall  promptly 
inform  the  local  health  authorities  of  the  existence  of  such  disease 
aboard  and  shall  make  every  effort  to  furnish  such  notification  in  ample 
time,  if  possible,  to  permit  of  the  case  being  seen  by  the  local  authori- 
.'ties  before  discharge  from  the  vessel." 

That  was  done  with  regard  to  the  cases  of  infectious  diseases  passed 
on  vessels.  With  regard  to  vessels  arriving  with  these  diseases  on 
board,  no  particular  measures  are  taken  at  the  quarantine  station,  as 
we  are  not  dealing  with  a  quarantinable  disease. 

In  following  this  practice  we  have  reduced  very  considerably  the 
foreign  source  of  infectious  disease  entering  our  seaports.  I  think  that 
it  would  be  a  valuable  protection  and  addition  for  the  sanitation  of  a 
seaport  town  if  every  measure  and  every  precaution  necessary  is  taken 
to  eliminate  foreign  sources  of  infection. 

The  President.     Let  us  take  a  vote  on  the  motion  of  Dr.  Soto. 

Dr.  Liceaga.  I  beg  to  make  a  remark  on  Dr.  Soto's  motion.  He 
wants  it  referred  to  the  consideration  of  the  Committee  on  Sanitation 
of  Ports,  but  I  believe  that  it  should  be  submitted  to  Committee  in 
'.charge  of  Sanitary  Measures. 

Dr.  Soto.     I  accept  the  amendment. 

Dr.  Wyman.  The  proper  way  would  be  to  have  a  resolution  in- 
troduced and  referred  to  this  Committee,  but  I  do  not  just  know  who 
are  on  this  Committee  until  I  get  the  list  this  afternoon,  but  I  propose 
to  call  a  meeting  of  that  Committee  in  due  course  of  time,  probably 
tomorrow,  and  we  might  just  consider  that  matter  referred  to  the 
Committee. 

Dr.  Soto.  Do  I  understand  that  that  is  the  way  of  submitting  all 
this  ? 

The  President.  All  these  propositions  or  projects  of  resolutions 
should  be  referred  to  the  respective  committees. 

(The  point  was  decided  in  the  manner  suggested.) 

The  Secretary,  Dr.  Razetti,  read  a  telegram  from  Puerto  Limon, 
announcing  the  arrival  of  the  Delegate  from  Salvador,  Dr.  Alfonso 
■Quinones,  and  the  President  requested  the  Secretary  to  go  to  the  rail- 
road depot  to  meet  that  Delegate. 

On  motion  of  Dr.  Wyman,  duly  seconded,  the  session  adjourned  at 
5  P.  M. 


FOURTH   INTERNATIONAL  SANITARY  CONFERKNCE.  57 


FOURTH  DAY,  WENESDAY,  DECEMBER  29,  1909. 
Morning  Session. 

The  Conference  was  called  to  order  at  9:30  A.  M.  by  President 
UUoa,  the  following  Delegates  being  present :  Drs.  Amador,  Roberts^ 
Quifiones,  Wyman,  Amesse,  von  Ezdorf,  Liceaga,  Monjaras,  Toledo, 
Vasquez,  Porras,  Acosta,  Razetti,  Ulloa,  Duran,  Soto,  Rojas,  and 
Castro. 

The  President.  As  the  Spanish  minutes  for  the  previous  session 
are  not  yet  ready,  they  will  be  read  in  this  afternoon's  session. 

(The  President  introduced  the  Delegates  from  Salvador  and  Nica- 
ragua, Drs.  Alfonso  Quifiones,  and  Dr.  Vicente  Castro  Cervantes,  re- 
spectively.) 

The  President.  I  request  the  Delegates  that  they  follow  strictly 
the  parliamentary  provisions  with  respect  to  the  period  and  number  of 
times  in  which  they  can  take  the  floor,  in  order  that  we  may  make 
possible  the  multiple  and  enormous  work  in  the  Secretary's  office. 
(The  President  then  made  an  explanation  in  regard  to  the  nature  and' 
character  of  the  work  of  the  Conference.) 

The  Delegate  from  Salvador,  Dr.  Ouinones,  after  stating  the 
causes  that  prevented  him  from  attending  the  inauguration  of  the  Con- 
ference, read  his  report,  which  appears  on  page  153  of  the  Appendix.. 

The  President.  The  Delegate  from  Nicaragua,  Dr.  Castro,  having 
been  just  appointed,  has  had  no  time  to  prepare  his  report,  and  he  re- 
quests that  he  be  allowed  to  read  it  another  time. 

We  shall  now  proceed  with  the  pending  discussion  on  the  sanitary 
condition  of  ports  and  measures  that  may  be  proposed  for  the  better- 
ment of  such  conditions.     The  discussion  is  therefore  opened. 

The  Secretary,  Dr.  Pv.azf.tti,  read  the  list  of  the  Delegates  who 
constitute  the  Executive  Comm.ittee. 

The  President.  In  order  to  give  that  Committee  time  to  prepare 
the  subjects  that  are  to  be  submitted  to  the  discussion  of  the  Confer- 
ence, I  shall  adjourn  the  session  half  an  hour  before  the  usual  time. 

Following  the  order  of  the  program,  we  now  come  to  the  reports  on 
the  Registration  of  Population  and  the  rate  of  mortality  in  the  respec- 
tive countries,  and  the  discussion  of  said  reports ;  to  this  end  we  shall 
do  away  with  the  alphabetical  order  of  the  nations  represented,  and  I 
request  the  Delegates  who  have  such  reports  to  present  them. 

I  request  Dr.  Wyman  to  submit,  as  soon  as  he  is  ready,  the  report 
of  the  committee  of  which  he  is  the  chairman,  and  then  formulate  the 
resolutions  pertaining  to  the  difTerent  ports  and  cities  and  send  them 
to  the  table  so  that  we  may  continue  with  the  discussion  of  the  subjects 
at  the  following  session. 

Dr.  Wyman.  Would  it  be  proper  to  convene  the  committee  during 
the  session,  or  between  sessions? 

The  President.     Well,  we  will  leave  that  to  you. 


58  FOURTH    liXTERN'ATIONAL   SANITARY    CONFERENCE. 

Dr.  Wyman.  I  contemplated  calling  that  committee  immediately 
after  this  morning's  session. 

The  President.  We  shall  end  the  session  early  so  as  to  give  you 
time. 

Dr.  Amesse.    Are  you  going  to  call  the  roll  of  countries  ? 

The  President.  No.  Any  special  report  will  be  received  from 
anybody. 

Dr.  Amesse.  Mr.  President  and  Delegates,  this  report  is  relative 
to  the  registration  of  population  and  rate  of  mortality  in  the  United 
States  for  the  year  1908.  (The  report  appears  on  page  190  of  the 
Appendix.) 

Dr.  Monjaras  submitted  his  report  verbally  in  Spanish,  exhibiting 
several  comprehensive  and  interesting  statistical  tables. 

Dr.  Roberts  submitted  his  report  in  Spanish. 

Dr.  Monjaras  then  asked  him  if  in  the  Republic  of  Cuba  was  pub- 
lished the  Weekly  Statistical  Bulletin,  which  question  gave  rise  to  a 
discussion  in  which  each  of  those  Delegates  took  the  floor  twice,  and 
the  point  was  completely  explained. 

The  session  then  adjourned  at  10:30  A.  M. 

Afternoon  Session. 

The  Conference  was  called  to  order  by  Dr.  Ulloa  at  2:35  P.  M., 
the  following  Delegates  being  present :  Drs.  Amador,  Roberts,  Qui- 
iiones,  Wyman,  Amesse,  von  Ezdorf,  Liceaga,  Monjaras,  Vasquez, 
Porras,  Acosta,  Razetti,  Ulloa,  Duran,  Soto,  and  Castro. 

The  Spanish  minutes  of  yesterday's  session  were  read  and  approved. 
During  its  discussion,  Dr.  Duran  stated  that  he  was  gratified  to  see 
that,  although  his  motion  regarding  the  manner  in  which  minutes 
should  be  read  was  voted  down,  it  was  now  being  followed. 

The  President  stated  that  on  account  of  the  illness  of  the  stenog- 
rapher it  was  impossible  to  give  in  full  the  speeches  of  the  Delegates, 
and  he  requested  that  any  one  of  them  would  be  so  kind  as  to  make  a 
motion  to  reconsider  the  proposal  by  Dr.  Duran  to  the  effect  that  the 
minutes  be  read  in  extracted  form,  and  that  while  existing  difficulties 
were  not  overcome,  he  requested  of  the  Delegates  to  go  to  the  Secre- 
tary's office  to  revise  their  remarks. 

Dr.  Vasquez  presented  the  motion  referred  to,  which  was  approved, 
together  with  the  aforesaid  minutes. 

The  President  stated  that  he  had  received  a  committee  composed 
of  the  Licenciado  Don  Leonidas  Pacheco  and  Dr.  Jose  Maria  Castro, 
offering  the  Delegates  a  dance  in  the  National  Theater  on  the  31st 
instant,  which  was  dedicated  to  the  Conference  by  the  Costa-Rican 
Society,  and  requested  the  Delegates  to  suggest  the  manner  in  which 
that  offer  should  be  answered. 

Dr.  Liceaga  made  a  motion,  which  was  carried,  authorizing  the 
President  to  accept  the  offer  in  the  name  of  the  Delegates. 

The  President  reminded  the  Delegates  that  at  9  o'clock  this  evening 
would  be  held  the  reception  in  the  Legation  of  the  Mexican  United 
States,  and  announced  that  the  Conference  was  to  proceed  with  re- 
ports upon  mortality  and  morbidity  statistics  and  discussion  of  the 
same. 


FOURTH  INTERNATIONAL  SANITARY  COiNFERENCE.  59 

Drs.  Razetti,  Vasquez,  Quinones  and  Duran,  to  whom  Dr.  Soto 
yielded,  read  their  respective  reports. 

Dr.  Castro  read  a  speech  and  excused  himself  for  not  having  been 
able  to  obtain  the  necessary  data,  on  account  of  having  been  disap- 
pointed and  to  the  special  circumstances  existing  in  the  country  which 
he  represents. 

Dr.  Porras  stated  that  the  report  that  he  had  presented  covered  the 
subject  under  discussion. 

The  President  made  explanations  in  regard  to  the  statistical  fig- 
ures read  by  Dr.  Duran,  stating  that  there  appears  to  be  more  mor- 
tality in  San  Jose  than  that  which  really  exists,  due  to  the  fact  that 
patients  come  to  the  hospitals  of  San  Juan  de  Dios  from  other  ports  of 
the  Republic,  and  the  same  is  the  case  in  Limon,  where  are  gathered  all 
the  patients  of  the  coast  line,  with  the  result  that  such  deaths  are 
charged  to  those  cities,  although  properly  belonging  to  other  sections 
of  the  Republic. 

Dr.  Monjaras  made  a  few  general  remarks  in  order  to  make  such 
statistics  as  uniform  as  possible,  and  regarding  the  most  scientific  way 
of  keeping  demographic  records. 

Dr.  Wyman.  Mr.  President,  it  seems  that  no  shorthand  notes 
were  taken  of  Dr.  Monjaras'  address,  and  it  seems  to  me  that  some 
things  in  his  address  should  appear  in  the  printed  report,  and  I  would 
suggest,  if  it  meets  your  approval,  that  he  be  invited  to  write  out  what 
he  has  said,  or  a  summary  of  it  for  inclusion  in  the  printed  proceedings. 

The  President.  At  the  beginning  of  the  session,  when  I  explained 
the  difficulties  we  were  laboring  under  on  account  of  our  Spanish 
stenographer  being  sick,  I  requested  all  those  who  made  motions  to 
pass  them  in  to  the  Secretary's  office,  and  also  their  speeches. 

All  motions  were  taken  note  of  and  I  shall  make  it  a  point  to  call 
Dr.  Monjaras'  attention  to  this. 

Dr.  Wyman.  Mr.  President,  when  you  are  through  with  the  par- 
ticular subject,  I  should  like  to  be  informed  and  to  have  the  privilege 
of  presenting  a  resolution  which  would  go  to  the  proper  committee. 

Dr.  Amador  addressed  the  Conference  relative  to  vital  statistics, 
tuberculosis,  etc.,  in  the  Spanish  language. 

The  President  addressed  the  Conference  in  Spanish  and  signified 
to  Dr.  Wyman  to  proceed. 

Dr.  Wyman.  Mr.  President,  I  will  ask  the  stenographer  in  English 
to  take  this  down  as  I  read  it,  and  I  would  ask  further  that  yourself, 
or  Dr.  Vasquez,  repeat  my  language  paragraph  by  paragraph,  so  that 
the  other  Delegates  may  understand. 

Dr.  Vasquez  was  appointed  to  do  so. 

Dr.  Wyman.  The  resolution  is  on  the  destruction  of  rats  on  ves- 
vels,  and  is  as  follows : 

Whereas,  plague  is  a  disease  which  is  carried  from  one  country  to  another 
by  the  rat,  and 

Whereas,  the  rat  commonly  infests  vessels  engaged  in  commerce,  and 

Whereas,  rats  in  vessels  may  be  destroyed  by  measures  that  are  not  difficult 
of  enforcement   and  that   involve  but   moderate   expense,   and 

Whereas,  the  further  spread  of  this  disease  among  the  countries  of  the 
Western  Hemisphere  is  a  matter  of  grave  concern  and  should  be  prevented  for 
the  sake  of  preserving  h,uman  life  and  for  the  preserving  of  commercial  pros- 
perity in  the  ports  of  the  American  Republics;  therefore  be  it 


60  FOURTH    INTERNATIONAL   SANITARY    CONFERENCE. 

Resolved,  That  it  is  the  duty  of  owners  and  masters  of  vessels  to  rid  their 
vessels  of  this  pest  and  to  keep  them  free  therefrom ;  and  be  it  further 

Resolved,  That  this  should  be  accomplished  by  the  periodical  fumigation  of 
holds  of  vessels  with  sulphur  gas  at  periods  of  from  three  to  six  months  and 
at  times  when  advantage  may  be  taken  of  the  vessels  being  free  from  cargo 
or  laid  up  for  repairs,  and  at  all  other  times  vigilance  shpuld  be  exercised  by  the 
masters  for  the  destruction  of  rats  by  such  other  means  as  they  may  deem 
most  effective. 

The  President.  I  leave  it  to  the  consideration  of  the  Conference 
whether  we  will  refer  this  resolution  to  one  of  the  committees  already- 
appointed  or  consider  it  under  the  sanitation  of  ports  and  cities. 

Dr.  Wyman.     I  will  turn  it  in. 

Dr.  Roberts  addressed  the  Conference  in  Spanish. 

The  President  addressed  the  Conference  in  Spanish. 

Dr.  Wyman.  It  might  go  to  your  committee,  Mr.  President,  on 
resolutions,  to  be  considered  and  reported  on  to  the  Conference,  or 
the  Committee  on  Sanitation,  just  as  you  see  fit,  but  it  does  not  apply 
to  the  Committee  on  Sanitation  of  Ports  particularly. 

The  President.  No,  not  particularly,  but  we  may  pass  it  over  tO' 
that  committee.     It  is  for  the  protection  of  passengers. 

Dr.  Wyman.  Why  can't  it  go  to  the  Committee  on  General  Reso- 
lutions?    It  is  a  general  resolution. 

The  President.     That  is  the  Executive  Committee. 

Dr.  Wyman.  The  Executive  Committee — ^your  advisory  com- 
mittee. 

The  President.     Yes,  it  might  be  considered  in  that. 

The  President  then  addressed  the  Conference  in  Spanish,  followed 
by  Dr.  Liceaga,  in  the  same  language. 

Dr.  Wyman.  Would  it  be  in  order  for  me  to  make  some  explana- 
tion of  this  resolution  now? 

The  President.  Yes.  I  think  it  would  be  better,  though,  when  we 
discuss  that  in  Executive  Committee. 

Dr.  Wyman.     Have  it  reported  tomorrow,  then? 

The  President.     Yes. 

Dr.  Wyman.     Shall  I  turn  it  over  to  you,  Mr.  President? 

The  President.     If  you  please,  sir. 

The  President  announced  that  in  accordance  with  the  order  of  the 
day,  and  there  being  no  further  remarks  to  be  made  on  the  subject 
under  discussion,  it  was  in  order  to  proceed  with  the  subject  on  meas- 
ures against  yellow  fever  and  malaria. 

Dr.  Liceaga  read  a  speech  in  regard  to  the  subject  just  referred  to, 
and  closed  it,  suggesting  an  amendment  to  Section  9  of  the  Sanitary 
Convention  of  Washington. 

The  President.     The  paper  is  opened  for  discussion. 

Dr.  Amesse.  Mr.  President,  I  would  like  to  know  from  Dr.  Liceaga 
if  it  is  possible  for  a  passenger  to  proceed  from  a  port  like  Merida  by 
way  of  Vera  Cruz,  embark  on  a  ship  there,  and  arrive  in  Havana  in 
less  than  six  days. 

The  President  translated  the  question  for  Dr.  Liceaga,  who  re- 
plied in  Spanish. 

The  President.  Dr.  Liceaga  says  it  is  three  days  from  Merida  to 
Vera  Cruz  and  three  days  from  Vera  Cruz  to  Havana ;  that  is  six 
days. 


FOURTH  INTERNATIONAL  SANITARY  CONFERENCE.  61 

Dr.  Amesse.  Well,  in  continuation,  if  you  will  allow  me,  I  would 
say  that  I  know  from  many  sources  in  Havana  that  the  only  reason 
Vera  Cruz  has  been  quarantined  against  is  because  of  this  fact,  that 
passengers  would  proceed  from  Merida,  which  is  infected  or  has  been 
infected,  by  way  of  Vera  Cruz,  make  their  connections  there  and  pro- 
ceed direct  to  Havana.  If  vessels  are  disinfected  in  the  port  of  Vera 
Cruz  the  elapsed  time  after  such  disinfection  will  count  in  the  period 
of  detention.  A  vessel  requires  three  days  to  come  from  Vera  Cruz, 
and  if  the  vessel  has  been  disinfected  before  sailing  that  three  days 
will  be  deducted  from  the  six  days  under  the  United  States  Regula- 
tions, but  a  great  many  ship  owners  will  not  permit  their  ships  to  be 
disinfected.  The  Ward  Line  will  not  permit  their  vessels  to  be  disin- 
fected at  Vera  Cruz  and  the  consequence  is  that  when  passengers  ar- 
rive at  Havana  from  Vera  Cruz  they  are  held  at  Triscornia  six  days, 
whereas  if  the  ship  had  been  disinfected  with  pyrethrum  at  very  little 
cost  they  could  proceed  from  Triscornia  in  three  days  because  it  is  a 
three  days"  trip.  If  the  ship  owners  would  co-operate  with  us  we  could 
reduce  that  six  days  to  three  days  in  quarantine. 

The  President  translated  the  above  to  Dr.  Liceaga  and  Dr.  Liceaga 
replied  in  Spanish. 

The  President.  Dr.  Liceaga  says  that  all  the  vessels  are  fumi- 
gated by  them,  even  the  vessels  of  the  Ward  Line,  and  that  even  if 
the  Mexican  authorities  didn't  do  it  that  your  agent  at  Vera  Cruz 
would  compel  them  to. 

Dr.  Amesse.  I  beg  to  differ  with  Dr.  Liceaga  in  stating  that  no 
Ward  Line  vessel  has  been  disinfected  except  when  disease  has  been 
found  aboard.  I  can  give  you  that  in  writing  from  the  Superintendent 
of  the  Line.  The  Cuban  Government  has  an  officer  at  Vera  Cruz,  but 
so  far  as  I  can  find  out  he  does  nothing  because  he  is  not  permitted 
to  fumigate  vessels  proceeding  from  that  port.  Last  year  he  was 
allowed  to  fumigate  ships  of  the  Spanish  Transatlantic  Line,  the  Ham- 
burg-American Line  and  the  French  Line  and  passengers  on  those 
lines  were  held  in  Triscornia  but  one  day,  while  those  of  the  Ward 
Line  were  held  six  days  from  arrival.  No  vessels  of  the  Ward  Line 
have  been  fumigated  in  Vera  Cruz  at  all.  That  is  official  and  I  can 
prove  it. 

The  President  translated  the  above  remarks  to  Dr.  Liceaga,  and 
after  a  discussion  with  the  latter,  spoke  in  English  as  follows : 

The  President.  Dr.  Liceaga  says  that  he  promises  to  oblige  the 
different  steamers  or  vessels  sailing  from  Vera  Cruz  to  be  fumigated 
and  then,  of  course,  the  treatment  ceases  because  of  that  fumigation. 
He  insists  on  that,  although  I  called  his  attention  to  the  possibility  of 
infection  being  carried  by  mosquitoes  which  may  not  have  completed 
their  time  and  might  be  on  the  vessel  and  bite  someone  who  would  de- 
velop the  sickness  afterward. 

Dr.  Amesse.  Mr.  President,  I  was  speaking  for  Cuba  and  not  for 
the  United  States.  I  would  say  for  the  information  of  the  Confer- 
ence that  all  vessels  leaving  Vera  Cruz  for  the  United  States  are  fumi- 
gated by  our  officer  and  on  arrival  at  quarantine  the  time  of  passage 
from  port  to  port  is  deducted.  It  is  so  at  New  Orleans  and  other 
ports  where  similar  conditions  exist,  but  at  Cuba  the  detention  is  six 
full  days  because  the  steamship  lines  will  not  allow  fumigation.    The 


62  FOURTH   INTERNATIONAL  SANITARY   CONFERENCE. 

United  States  officer  at  Vera  Cruz  cannot  insist  on  their  fumigation 
because  they  are  going  to  a  foreign  port. 

Dr.  Monjaras  addressed  the  Conference  in  Spanish. 

The  President.  Dr.  Monjaras  says  that  no  passenger  goes  from 
Merida  to  Havana  by  way  of  Vera  Cruz;  that  they  leave  Merida,  go 
to  Progreso  and  proceed  from  Progreso  to  Havana.  In  that  case 
there  would  be  no  use  in  that  question. 

Dr.  Amesse.  All  the  steamship  lines  do  not  touch  at  Progreso; 
for  example  Spanish  passengers  want  to  go  on  a  Spanish  line.  They 
do  not  go  to  Progreso,  they  go  to  Vera  Cruz  and  get  it.  We  have  a 
record  of  passengers  who  came  by  way  of  Vera  Cruz  into  Havana. 

Dr.  Monjaras  addressed  the  Conference  in  Spanish. 

Dr.  Von  Ezdorf.  In  our  classification  of  ports  which  we  quaran- 
tine we  have  infected  ports  and  suspected  ports.  Now  the  suspected 
ports  are  such  ports  as  are  in  infectible  territory  and  have  communica- 
tion with  infected  ports.  It  has  been  observed  in  the  past  that  those 
suspected  ports,  while  they  have  apparently  remained  clean,  have  been 
taking  in  people  from  the  infected  territory  and  those  ports  might 
therefore  have  some  case  develop  yellow  fever  and  thereby  infect 
some  mosquitoes  in  that  territory.  Now,  it  has  happened  more  than 
■once,  and  is  going  to  happen  again,  so  that  we  are  running  a  risk  in 
having  communication  with  suspected  ports  in  that  there  may  be  some 
unknown  infection  at  that  port  which  may  in  turn  infect  some  indi- 
vidual coming  to  our  ports  in  the  United  States;  that  is  to  say,  to 
some  territory,  infectible  territory  which  we  have  in  the  south,  which 
we  are  guarding  by  quarantine  measures  against  suspected  as  well  as 
infected  ports.  As  Dr.  Amesse  said,  we  have  been  fumigating  vessels  at 
the  suspected  ports  as  well  as  infected  ports,  so  that  the  time  in  transit 
of  the  vessel  has  been  counted  and  deducted  from  the  period  of  obser- 
vation that  would  otherwise  hold  good  if  the  vessel  had  not  taken 
that  precaution  of  fumigation  at  the  foreign  port.  Now,  I  might  as 
well  illustrate  this  with  regard  to  Mexico,  and  I  can  illustrate  this  prin- 
ciple by  an  experience  I  had  in  Colon  in  1905.  There  was  a  person 
who  left  Managua,  apparently  a  healthy  place,  and  went  to  a  seaport 
which  was  reported  as  clean,  no  yellow  fever  having  been  known  to 
occur  there,  although  that  place  itself  had  had  communication  undoubt- 
edly with  some  infected  territory.  That  individual  slept  there  over 
night,  went  to  Panama,  completed  his  period  of  observation  of  five 
days ;  he  arrived  at  Colon,  embarked  on  a  vessel  bound  for  New  York. 
The  vessel  didn't  sail  until  the  following  day  and  during  the  night  that 
individual  was  taken  sick.  He  was  at  once  taken  to  a  hospital  and 
isolated  and  a  positive  diagnosis  of  yellow  fever  was  made.  He  died 
five  days  later.  This  shows  an  incubation  period  of  five  days  and  six- 
teen hours.  That  simply  illustrates  the  danger  which  we  have  to  guard 
against  with  regard  to  suspected  ports,  ports  which  remain  infectible 
and  are  having  communication  with  known  infected  territory.  Prob- 
ably Dr.  Liceaga  will  remember  when  yellow  fever  occurred  in  Lagu- 
na,  I  think  just  two  years  ago,  in  a  vessel  which  came  from  Venezuela 
and  infected  that  port.  Although  none  of  the  ports  along  the  coast 
were  known  to  be  infected,  yet  they  had  communication  with  this  only 
known  source  of  infection,  which  was  then  Laguna,  and  thereby  by 
having  this  communication  with  this  infected  port  they  became  sus- 


FOURTH  INTERNATIONAL  SANITARY  CONFERENCE.  63 

pected  and  we  were  careful  enough  at  the  time,  as  soon  as  we  knew 
the  communication  was  going  on,  free  communication,  to  regard  those 
places  as  suspected  and  take  the  precaution  which  we  always  take  of 
fumigating  vessels  at  those  ports  before  sailing  for  a  southern  port  in 
the  United  States.  It  was  not  very  long  before  a  case  of  yellow  fever 
was  found  in  Vera  Cruz  and  the  source  of  that  infection  in  Vera  Cruz 
was  unknown;  consequently  if  Laguna  is  accepted  as  the  only  known 
point  of  infection  it  must  have  been  from  Lagima  that  some  case 
finally  entered  Vera  Cruz  and  infected  that  port.  So  that  I  feel  it  is 
only  reasonable  where  a  territory  which  is  known  as  infectible  territory 
is  having  free  communication  with  infected  territory  without  detain- 
ing under  observation  every  individual  coming  from  that  place,  that 
we  should  take  those  official  precautions  and  regard  them  as  suspected 
ports. 

The  President  translated  Dr.  von  Ezdorf's  remarks  for  the  benefit 
of  the  Spanish  speaking  Delegates,  after  which  Dr.  Liceaga  addressed 
the  Conference  in  Spanish. 

Dr.  von  Ezdorf.  I  would  like  to  ask  Dr.  Liceaga  a  question  about 
this  vessel  which  developed  yellow  fever  at  Laguna.  Did  that  come 
from  a  known  infected  port  in  Venezuela?  Does  he  know  that?  Ap- 
parently he  took  no  precautions  with  that  vessel  at  all  until  the  disease 
developed. 

The  President.  I  understood  Dr.  Liceaga  to  say  that  he  under- 
stood there  were  some  cases  of  yellow  fever  in  that  part  of  Venezuela, 
but  he  was  not  sure. 

Dr.  von  Ezdorf.  Then  that  territory  was  really  suspected  territory. 
That  is  the  point  I  was  trying  to  make.  We  are  taking  precautions 
with  regard  to  that  suspected  territory.  Had  that  same  vessel,  in- 
stead of  going  to  Laguna,  come  to  the  United  States  that  vessel  would 
have  undergone  fumigation  and  detention  which  would  have  discov- 
ered the  infection  on  board  the  vessel. 

Then  followed  a  discussion  in  Spanish  between  the  President  and 
Dr.  Liceaga,  after  which  Dr.  Liceaga  read  from  a  pamphlet  in  Spanish. 

The  President.  Dr.  Liceaga  proposes  a  resolution  reforming  the 
Sanitary  Convention  at  Washington,  Article  IX.  Of  course  this  will 
be  referred  to  the  Committee  on  Yellow  Fever  and  this  committee  will 
at  the  proper  time  pass  upon  it  and  refer  it  to  the  Executive  Commit- 
tee, which  will  refer  it  back  to  the  Conference  for  discussion. 

Dr.  Roberts  addressed  the  Conference  in  Spanish  and  read  resolu- 
tions relative  to  yellow  fever. 

The  President.  Those  will  be  referred  for  consideration  to  the 
Yellow  Fever  Committee. 

The  Conference  then  adjourned  at  5  P.  M.  until  December  30,  1909, 
at  9  A.  M. 


64  FOURTH   INTERNATIONAL   SANITARY   CONFERENCE. 


FIFTH  DAY— THURSDAY,  DECEMBER  30,  1909. 
Morning  Session. 

The  Conference  was  called  to  order  by  President  Ulloa  at  9:30 
A.  M.,  the  following  Delegates  being  present:  Doctors  Amador,  Rob- 
erts, Quinones,  Wyman,  Amesse,  von  Ezdorf,  Liceaga,  Monjaras, 
Acosta,  Razetti,  Toledo,  Vasquez,  Porras,  Ulloa,  Duran,  Rojas,  Soto, 
Castro. 

The  Secretary,  Dr.  Razetti,  stated  that  he  was  unable  to  read  the 
minutes,  because  the  stenographer  had  not  given  him  a  copy  thereof, 
and  the  President  expressed  his  regret  that,  for  several  reasons,  the 
work  of  the  Secretary's  office  should  be  disorganized,  and  he  promised 
to  do  his  best  to  overcome  these  deficiencies. 

The  Secretary  for  the  English  section,  Dr,  von  Ezdorf,  read  the 
minutes  for  the  afternoon's  session  of  December  28th,  which  were 
read  and  approved  without  discussion. 

The  Spanish  Secretary  read  a  communication  from  the  Minister 
of  Foreign  Affairs,  stating  that  the  credentials  of  Dr,  Vicente  Castro, 
as  delegate  from  Nicaragua  to  the  Fourth  International  Sanitary  Con- 
ference, had  been  examined  and  found  correct. 

The  President  read  a  telegram  from  the  Delegate  of  Chile  stating 
that  floods  interrupted  traffic,  but  that  he  would  come  on  the  first 
steamer. 

Dr.  Wyman.  Mr.  President,  I  understand  that  some  additional  in- 
formation of  a  very  grave  character  has  been  received  by  the  Delegate 
from  Guatemala,  and  if  it  is  now  in  order  for  him  to  present  it,  I  move 
that  he  be  allowed  five  minutes  for  that  purpose  to  complete  the  record 
for  the  published  proceedings. 

The  President  translated  the  remarks  of  Dr.  Wyman  into  Spanish. 

Dr.  Toledo  then  gave  some  data  showing  that  the  amount  of  $2,- 
000,000,  that,  as  was  said,  had  been  appropriated  for  the  sanitation  of 
Puerto  Barrios,  was  not  only  the  correct  one  but  that  more  than  said 
amount  had  been  spent  for  the  purpose,  and  to  prove  his  assertion  he 
made  reference  to  a  contract  entered  into  between  the  Government  of 
Guatemala  and  the  United  Fruit  Company  concerning  the  carrying  out 
of  the  sanitation  works  of  the  report  referred  to. 

The  President  asked,  in  Spanish,  whether  there  were  any  remarks 
to  be  made  on  the  subject  of  malaria. 

Dr.  Liceaga  made  a  report  on  the  campaign  that  was  being  carried 
out  in  Mexico  against  the  said  disease,  pointing  out,  among  other  meas- 
ures, the  organization  of  sanitary  squads  in  places  susceptible  to  the 
development  of  that  disease,  which  squads  were  charged  with  the  de- 
struction of  the  anopheles  mosquito,  employing  therefor  such  methods 
as  were  known ;  he  also  mentioned  the  appointment  of  traveling  rail- 
road inspectors  for  the  sanitation  service.  All  these,  Dr.  Liceaga  said,, 
were  independent  from  canalization  works,  drainage  of  swamps,  etc. 
He  then  spoke  of  the  difficulties  connected  with  the  isolation  of  patients 


FOURTH  INTERNATIONAL  SANITARY  CONFERENCE.  65 

in  cases  of  malaria ;  he  called  attention  to  the  fact  that  much  had  been 
done  in  Mexico  towards  educating  the  masses  by  means  of  pamphlets 
descriptive  of  etiology  and  treatment  of  the  disease,  and  closed  his 
remarks  saying  that,  as  a  prophylactic  means,  great  quantities  of  quin- 
ine are  distributed  in  all  the  sections  of  the  country  wherever  such 
disease  may  appear. 

Dr.  Duran  then  took  the  floor  to  emphasize  the  great  importance 
that  the  application  of  quinine  had  as  a  prophylactic  means,  especially 
when  there  were  great  difficulties  for  the  complete  destruction  of  the 
mosquitoes  in  all  places,  particularly  in  large  areas. 

Dr.  von  Ezdorf.  Mr.  President,  we  in  the  United  States  have  no 
jurisdiction  in  handling  malaria  in  the  various  States.  That  is  done  by 
the  several  State  and  municipal  health  authorities.  In  New  York  and 
New  Jersey  some  work  has  been  done  to  a  great  extent.  They  have 
drained  the  swamps,  as  it  is  in  the  swamps  where  the  anopheles  mos- 
quito breeds  in  particular.  Of  course  we  have  in  the  south  malaria  to 
a  great  extent  because  that  is  where  the  anopheles  prevail,  but  the 
States  in  the  south  are  adopting  measures  as  rapidly  as  possible,  that 
is,  drainage  and  good  water  supply,  and  other  sanitary  measures  so  as 
to  eliminate  so  far  as  possible  the  malaria  mosquito.  Of  course, 
malaria  still  remains  in  the  south  where  they  have  large  swamps,  and 
it  remains  for  them  to  do  a  great  deal  of  work  toward  draining  these 
swamps.  The  one  thing  that  is  being  done  by  the  United  States  Gov- 
ernment, in  effect  but  not  intentionally,  to  eliminate  the  foreign  source 
of  malarial  infection  is  done  at  its  quarantine  stations ;  for  example,  at 
my  station,  and  I  think  it  to  be  the  case  also  at  Mobile,  Ala.,  and 
Tampa,  Fla.,  that  a  case  arriving  from  the  tropics  found  to  be  sick  or 
having  fever,  is  detained  at  the  quarantine  station  for  observation  and 
treatment ;  in  that  way  we  have  eliminated  to  a  great  extent  the  impor- 
tation of  additional  infection  of  malaria  into  our  southern  country.  In 
that  way,  also,  I  determined,  during  the  year  1907,  that  there  was  a 
particular  wharf  in  the  Canal  Zone  which  was  infecting  ships,  that  is 
to  say,  there  was  malarial  infection  of  the  asstivo  autumnal  variety 
at  that  wharf  so  that  crews  coming  on  board  vessels  lying  alongside 
that  wharf  would  arrive  at  our  station  with  that  particular  infection. 
So  also  have  I  determined  with  regard  to  Tampico,  as  Dr.  Liceaga 
states  in  connection  with  malaria  in  his  country.  I  have  discovered  in 
the  same  way  and  determined  that  malaria  was  prevailing  and  infecting 
crews  of  vessels  coming  from  Tampico  during  the  latter  part  of  this 
year.  The  only  point  I  wish  to  make  is  that  so  far  as  the  United  States 
is  concerned  we  are  at  our  quarantine  stations  eliminating  the  addi- 
tional infection  of  malaria  from  our  country. 

Dr.  Monjaras,  referring  to  the  remark  of  Dr.  Duran,  said  that  the 
question  of  large  territorial  areas  was  no  great  obstacle  in  the  cam- 
paign against  malaria  because  the  main  point  was  the  destruction  of 
mosquitoes  in  the  suburbs  of  cities,  towns,  or  settlements,  and  not 
wherever  the  mosquito  may  be  found ;  but  it  was  sufficient  to  destroy 
the  larvae  in  the  inhabited  places  and  their  surroundings,  organizing 
squads  charged  with  the  duty  of  inspecting  once  a  week  such  places  as 
should  be  made  healthy.  He  closed  his  remarks  by  saying  that  he 
was  in  accord  with  the  principle  that  quinine  should  be  administered 
in  prophylactic  doses. 


66  FOURTH   INTERNATIONAL   SANITARY   CONFERENCE. 

The  President  at  this  moment  called  the  attention  of  the  Delegates 
to  the  fact  that  the  discussions  should  be  confined  to  the  subjects  of 
the  provisional  program,  in  order  to  advance  as  much  as  possible  the 
great  amount  of  work  before  the  Conference. 

The  President  stated  that  it  was  now  in  order  to  discuss  the  re- 
port on  the  mortality  and  morbidity  statistics  of  the  different  coun- 
tries. 

Dr.  Roberts  took  the  floor,  referring  to  the  statistical  data  contained 
in  the  report  that  he  had  read  in  a  previous  session. 

Dr.  Castro  spoke  of  the  advisability  that  statistics  regarding  ma- 
laria, if  they  were  to  be  correct,  should  be  based  upon  microscopical 
diagnosis. 

Dr.  Roberts  stated  that  the  malaria  cases  in  Cuba  were  generally  in- 
spected by  a  special  commission  called  "Special  Committee  on  Infec- 
tious Diseases,"  pointing  out  also  the  fact  that  there  were  good  labora- 
tories where  the  diagnosis  on  malaria  cases  could  be  verified. 

Dr.  Liceaga  and  Dr.  Monjaras  stated  that,  as  a  general  rule,  it 
was  sufficient  to  possess  clinical  knowledge  of  diagnosing  malaria  in 
the  majority  of  cases,  which  is  the  most  important  point  for  the  prepa- 
ration of  statistics  because  according  to  the  rules  of  epidejmiology, 
when  malaria  is  general  in  a  locality,  one  must  take  into  consideration 
as  if  it  were  an  actual  case  of  malaria,  even  those  cases  which  are 
not  of  the  true  type  of  malaria  from  the  clinical  or  bacteriological 
point  of  view. 

The  President.  I  have  called  the  attention  of  the  Conference  to 
the  official  program  which  says  "discussion  on  the  different  papers  pre- 
sented with  reference  to  sanitary  measures  against  yellow  fever  and 
malaria"  based  on  the  provisional  program  sent  by  the  International 
Sanitary  Bureau  of  Washington,  which  says  "discussion  of  new  dis- 
coveries regarding  the  transmission  of  yellow  fever  and  malaria  by 
other  means  than  mosquitoes."  I  am  very  sorry  to  have  to  call  the 
attention  of  my  colleagues  to  this  point,  but  they  are  going  outside  of 
our  program,  and  although  the  discussion  is  a  very  important  one  we 
cannot  take  it  up  here.  It  is  a  matter  for  discussion  in  a  medical  con- 
gress or  congress  where  general  matters  with  regard  to  these  things 
are  taken  up.  We  cannot  deal  with  those  things.  We  have  to  take  it 
for  granted  that  they  have  the  proper  authorities,  organizations,  and 
boards  of  health,  and  I  cannot  put  in  doubt  either  that  the  physicians 
of  the  different  countries  do  not  know  enough  to  diagnose  a  case 
of  yellow  fever  or  malaria.  Those  things  should  be  discussed  else- 
where. That  is  my  way  of  thinking  and  I  request  my  colleagues  to 
let  me  know  if  I  am  right  or  not. 

A  vote  was  taken  and  the  position  of  the  President  sustained. 

There  being  no  further  discussion,  another  subject  of  the  program 
was  taken  up,  that  relating  to  protective  measures  against  tuberculosis, 
bubonic  plague,  trachoma,  and  beri-beri. 

At  this  moment  Dr.  Liceaga  took  the  Chair  temporarily. 

Dr.  Razetti  stated  that  tuberculosis  caused  in  his  country  some- 
thing like  five  thousand  deaths  annually,  and  that  for  the  purpose  of 
fighting  the  spread  of  that  scourge  an  anti-tuberculosis  league  had  been 
created,  of  which  mention  was  made  in  his  general  report. 


FOURTH  INTERNATIONAL  SANITARY  CONFERENCE.  67 

Dr.  Rojas  verbally  submitted  a  resolution  providing  that  this  Con- 
ference appoint  an  international  commission  to  prepare  a  pamphlet 
written  in  simple  language  and  within  reach  of  all,  descriptive  of  the 
campaign  against  malaria. 

The  President  Pro  Tem.  I  request  the  Delegate  to  submit  his 
proposition  in  writing. 

Dr.  Ulloa  resumed  the  Chair. 

The  President.  We  are  not  going  to  have  any  special  festivities 
this  afternoon,  so  I  would  like  to  have  another  session  of  the  Confer- 
ence to  get  on  with  our  work,  as  we  have  a  good  deal  to  do  yet. 

The  session  was  adjourned  at  11  A.  M. 


Afternoon  Session. 

The  Conference  was  called  to  order  by  President  Ulloa  at  2:55 
P.  M.,  the  following  Delegates  being  present :  Drs.  Amador,  Roberts, 
Quifiones,  Wyman,  Amesse,  von  Ezdorf,  Liceaga,  Monjaras,  Toledo, 
Vasque;^,  Porras,  Acosta,  Razetti,  Ulloa,  Duran,  Soto  and  Castro. 

The  Secretary,  Dr.  Razetti,  read  minutes  for  the  previous  session, 
which  were  approved  after  discussion. 

The  Secretary,  Dr.  von  Ezdorf,  read  the  English  minutes  for 
the  morning  and  afternoon  sessions  of  December  29th,  which  were 
approved  without  discussion. 

The  Secretary,  Dr.  Razetti,  read  the  Spanish  minutes  in  full  as 
finally  copied  in  the  minute  book,  for  the  inaugural  session,  which  were 
also  approved. 

A  telegram  was  read  from  Dr.  Vial,  Delegate  from  Chile,  saying  that 
he  expected  to  arrive  in  the  afternoon,  together  with  his  wife,  and  the 
President  designated  Dr.  Soto,  of  the  Delegation  of  Costa  Rica,  to  go, 
together  with  the  ladies  of  the  Venezuelan  Delegation  and  Miss  Ulloa, 
to  the  depot  to  meet  the  Chilian  Delegate  and  Madame  Vial. 

The  President  stated  that  the  discussion  would  be  continued  with 
regard  to  plague,  tuberculosis,  trachoma,  and  beri-beri. 

Dr.  Duran,  after  a  brief  statement,  presented  a  resolution  for  the 
protection  of  laborers  against  malaria,  which  proposition,  after  being 
read  in  Spanish  and  English,  was  referred  to  the  respective  committee 
for  consideration. 

The  President.  Are  there  any  other  resolutions  or  discussions 
with  regard  to  malaria,  tuberculosis,  yellow  fever  or  plague? 

Surgeon-General  Wyman.  No  resolution  that  I  know  of,  but  we 
have  some  remarks  to  make  upon  the  subject,  if  they  are  in  order  now. 

The  President.  They  are  in  order.  Anything  with  regard  to  these 
topics. 

Dr.  Amesse.  In  the  preliminary  report  of  the  United  States  Dele- 
gation there  was  a  review,  a  short  resume,  of  the  work  done  in  the 
United  States  with  regard  to  plague  and  tuberculosis.  That  was  gone 
into  in  extenso  and  will  be  published  in  the  proceedings.  Regarding 
trachoma  it  appears  the  time  has  arrived  when  we  should  take  some 
concerted  action  not  only  regarding  trachoma  and  beri-beri  but  also 


68  FOURTH    INTERNATIONAL   SANITARY    CONFERENCE. 

regarding  favus  and  leprosy.  The  paper  read  by  Surgeon-General 
Wyman  at  the  Conference  in  Mexico  made  mention  of  the  fact  that 
since  1897  trachoma  has  been  considered  a  dangerous  contagious  dis- 
ease and  in  accordance  with  our  immigration  laws  arriving  aliens  so 
afflicted  are  refused  entrance  to  the  country.  Now,  the  report  sent  in 
by  the  Delegates  at  that  Convention  showed  that  trachoma  and  beri- 
beri were  at  that  time  practically  unknown  in  various  South  American 
and  Central  American  countries  while  laws  similar  to  our  own  were 
enforced  in  Brazil,  Cuba  and  Mexico.  (He  then  read  report  on  page 
185  of  the  Appendix.)  I  would  request  that  in  view  of  the  import- 
ance of  this  Dr.  Vasquez  act  as  interpreter  for  the  Spanish  Delegates. 

Dr.  Vasquez  translated  the  above  remarks  into  Spanish  as  requested. 

Dr.  Liceaga  stated  that  in  the  Mexican  immigration  law  beri-beri 
was  included  among  the  diseases,  the  admission  of  which  is  prohibited. 

The  President.    Is  there  any  Delegate  who  wishes  to  take  the  floor? 

(There  being  nobody  desiring  to  take  the  floor,  the  discussion  on  the 
subject  was  closed.) 

The  President.  Are  there  any  reports  of  committees  to  be  pre- 
sented ? 

Dr.  Wyman.  We  have  the  report  of  the  Committee  on  Sanitation 
of  Ports,  which  I  would  like  to  read,  and  then  it  would  go  to  the 
Executive  Committee,  as  I  understand  it. 

The  President.     Yes,  sir. 

Dr.  Wyman.  I  believe  that  Dr.  Liceaga  has  translated  it  into  Span- 
ish, so  I  will  read  the  English  and  afterwards  he  may  read  the  Spanish. 

(He  then  read  the  report  of  the  Committee  on  Sanitation  of  Cities 
and  Seaports,  which  appears  on  page  107  of  the  Appendix.) 

Dr.  Liceaga  then  read  the  same  resolutions  in  Spanish. 

Dr.  Wyman.  Mr.  President,  I  have  a  resolution  to  offer  which  we 
invited  Dr.  Liceaga  to  join  with  the  committee  in  preparing.  I  move 
that  we  be  allowed  to  affix  his  name  to  the  resolutions.  If  that  motion 
is  acceptable  I  suppose  it  would  go  to  the  Executive  Committee. 

The  President.  That  has  to  go  to  the  Executive  Committee  be- 
cause Dr.  Liceaga  does  not  appear  in  that  committee  and  no  motion 
has  been  made  to  that  effect.  It  was  entirely  unknown  to  me  that  he 
was  a  member  of  that  committee. 

Surgeon-General  Wyman.  We  invited  him  to  join  with  us,  not 
as  a  member  of  the  committee,  but  simply  to  assist  us.  Another 
matter,  Mr.  President.  Unless  there  is  objection  to  the  contrary  these 
resolutions  would  be  forwarded  by  the  International  Sanitary  Bureau 
to  the  Conference  at  Buenos  Ayres,  as  that  Bureau  is  charged  with 
the  disposal  of  resolutions  adopted  by  the  Conference.  We  would 
like  to  have  you  consider  that  at  any  rate,  and  if  there  is  no  objection — 
it  would  make  no  particular  difference — but  if  there  is  no  objection  it 
will  be  done  that  way. 

The  President  stated  this  proposition  to  the  Conference,  in  Spanish, 
which  was  approved  without  discussion. 

The  President  then  asked  if  there  were  any  other  resolutions  to  be 
offered  by  committees,  and  there  being  no  response,  he  stated  that  the 
Conference  would  proceed  to  the  next  subject  on  the  program,  regard- 


Photri  by  Harris  and  Evjing 

Dr.  Eduardo  Liceaga,  President  of  the  Supreme  Council  of  Healh  of 

Mexico, 
President  of  the  Third  International  Sanitary  Convention  of  American  Republics. 


The  Late  Dr.  Martin  Amador,  of  Colombia, 

Delegate  from  Colombia  to  the  Fourth  Sanitary  Conference  of  the 
American  Republics,  held  in  San  Jose  de  Costa  Rica,  1909-1910. 

In  the  early  part  of  March  of  the  present  year,  our  very  esteemed 
colleague,  Dr.  Martin  Amador,  who  represented  the  Republic  of  Co- 
lombia in  the  Fourth  International  Sanitary  Conference  of  the  Ameri- 
can Republics,  held  in  San  Jose,  Costa  Rica,  from  December  25,  1909, 
to  January  3,  1910,  died  in  the  Borough  of  Brooklyn,  New  York  City, 
where  he  had  lived  for  several  years. 

Dr.  Amador  was  born  in  the  city  of  Cartagena,  Republic  of  Colombia, 
in  1857,  and  graduated  as  Doctor  of  Medicine  and  Surgery  in  the  Uni- 
versity of  New  York  in  1877.  He  practiced  his  profession  with  re- 
markable success  in  Cartagena,  Costa  Rica,  and  later  in  Brooklyn.  He 
fulfilled  with  great  skill  the  position  of  Consul  of  Colombia  in  Hol- 
land and  in  Belgium,  and  Vice  Consul  of  the  United  States  of  Ameri- 
ca  in    Cartagena. 

His  genial  and  kind  personality  won  for  him  the  esteem  of  all  those 
who  knew  him,  and  those  of  us  who  had  the  privilege  of  being  his 
intimate  friends  will  always  deplore  his  loss,  because  Martin  Amador 
was  one  of  those  very  few  who  could  be  called  real  friends,  sincere 
under  all  circumstances  and  free  from  duplicity  and  envy. 

Upon  communicating  the  sad  news  of  the  death  of  the  Delegate  from 
Colombia  to  the  Fourth  Sanitary  Conference.  I  am  sure  the  senti- 
ments of  condolence  on  the  part  of  all  the  Delegates  will  be  unani- 
mous and  that  they  all  will  unite  with  me  in  expressing  our  deep 
sympathy  to  Mrs.  Amador  and  the  brothers  of  the  colleague  whose 
loss  we  sincerely  deplore. 

Juan  J.  Ulloa. 

New  York,  August  27,  1910. 


FOURTH  INTERNATIONAL  SANITARY  CONFERENCE.  69 

ing  the  appointment  of  three  physicians  to  be  made  by  the  different 
Delegations,  which  appointments  were  finally  made  in  the  following 
manner : 

Chile I  ( See  page  77 . ) 


I  Dr.  Amador    requested    that   he 


P  ,      ,  .  J       be  allowed  to  make    the    ap- 

L^olombia =n       pointments  at  another  session. 

I       (See  page  79.) 

f  Dr.  Carlos  Duran 

Costa  Rica <   Dr.  Elias  Rojas 

[_  Dr.  Jose  Maria  Soto  A. 

r  Dr.  Juan  Guiteras 

Cuba ^  Dr.  Enrique  B.  Barnet 

(^  Dr.  Aristides  Agramonte 

r  Dr.  A.  H.  Glennan 

United  States  of  America ^   Dr.  J.  W.  Kerr 

L  Dr.  John  W.  Trask 

r  Dr.  Eduardo  Liceaga 

United  States  of  Mexico <   Dr.  Jesus  Monjaras 

[_Dr.  Nicholas  Ramirez  de  Arellano 

r  Dr.  Pablo  Acosta  Ortiz 

United  States  of  Venezuela <   Dr.  Carlos  Manuel  Cabado 

[^Dr.  Luis  Razetti 

{Dr.  Tomas  G.  Palomo 
Dr.  Francisco  Guevara 
Dr.  Rafael  B.  Castro 

{Dr.  Salvador  Ortega 
Dr.  Juan  J.  Ortega 
Dr.  Jose  Azurdia 

r  Dr.  Jose  M.  Ochoa  Velasquez 

Honduras -<   Dr.  Ignacio  Castro 

l^  Dr.  Juan  Angel  Arias 

r  Dr.  Luis  Debayle 

Nicaragua A  Dr.  Rodolfo  Espinoza 

l^  Dr.  Juan  B.  Sacaza 

r  Dr.  Luis  Urriola 

Panama <|  Dr.  Alfonso  Preciado 

1  Dr.  Augusto  S.  Boyd 


The  President  called  attention  to  the  fact  that  the  appointments  for 
Chile  had  not  yet  been  made,  because  the  delegate  from  that  country 
was  absent,  but  that  he  would  be  requested  to  do  so  in  due  time. 

The  President  then  said  that  the  subject  relating  to  the  sanitation 
of  cities,  and  especially  of  ports,  was  now  open  for  discussion. 


70  FOURTH   INTERNATIONAL   SANITARY   CONFERENCE. 

Dr.  Duran.  The  Government  of  Costa  Rica  to-day  received  a  tele- 
gram from  our  Minister  in  Europe  to  the  effect  that  they  had  bought 
all  the  iron  work,  tubing,  etc.,  for  the  water-works  and  sewerage  of 
San  Jose,  which  materials  will  be  sent  very  soon  and  the  work  begun 
on  the  water  system,  and  it  is  hoped  will  be  completed  by  the  month 
of  May,  and  we  will  have  a  complete  sewerage  system  in  San  Jose 
in  two  years  from  now. 

Dr.  Liceaga.  In  order  not  to  repeat  what  I  have  said  in  regard  to- 
the  subject  under  discussion,  I  refer  the  Conference  to  the  general 
report  presented  by  the  Mexican  Delegation. 

The  President.  If  there  is  nobody  else  who  would  like  to  discuss 
the  subject  of  the  sanitation  of  ports  and  cities  further,  the  subject 
will  be  closed. 

Dr.  Amesse.  Mr.  President,  is  it  in  order  to  read  provisional  reso- 
lutions regarding  the  sanitation  of  ports? 

The  President.     Yes,  sir. 

Dr.  Amesse.  I  have  here  a  draft  of  resolutions  which  we  will 
introduce  tomorrow.  (He  then  read  the  resolutions,  which  appear 
on  page  107  of  the  Appendix.) 

Dr.  Vasquez  translated  the  said  resolutions  into  Spanish. 

The  President.  The  resolutions  will  be  referred  to  the  Committee 
on  the  Sanitation  of  Ports. 

Dr.  Castro  requested  that  he  be  allowed  to  refer  to  a  disease  called 
''Vitacia." 

The  President  called  his  attention  to  the  fact  that  that  disease  not 
being  included  in  the  order  of  the  day,  it  would  be  taken  into  considera- 
tion in  the  session  of  the  31st,  when  it  would  be  in  order  to  discuss  it. 

Dr.  Liceaga  made  a  few  remarks  with  respect  to  the  same  point. 

The  President.  The  subject  of  Sanitation  of  Ports  and  Cities 
having  been  sufficiently  discussed,  we  will  now  proceed  with  the  next 
one  on  the  program,  which  refers  to  measures  for  the  protection  of 
passengers  sailing  on  vessels  which  leave  infected  ports. 

Dr.  Roberts  stated  that  as  the  Delegation  of  Cuba  was  going  to 
submit  a  resolution  identical  with  another  one  of  the  Delegation  of  the 
United  States  of  America,  he  adhered  to  the  proposition  of  the  latter. 

Dr.  Amesse.  Mr.  President,  the  following  measures  employed  for 
the  protection  of  passengers  who  embark  in  vessels  from  infected  ports 
— the  regulations  deemed  advisable  by  the  Public  Health  and  Marine- 
Hospital  Service  of  the  United  States  for  the  protection  of  passengers — 
may  be  outlined  as  follows:  (He  then  read  the  paper,  which  appears 
on  page  192  of  the  Appendix.) 

Dr.  Vasquez,  on  request  of  the  President,  translated  the  remarks 
of  Dr.  Amesse  into  the  Spanish  language. 

(The  proposition  of  Dr.  Amesse  was  referred  to  the  respective  com- 
mittee. ) 

Dr.  Liceaga  read  a  paper  on  measures  for  the  protection  of  passen- 
gers who  embark  in. infected  ports.      (See  Appendix,  page  171.) 

The  President.  It  is  proposed  that  Dr.  Duran  be  added  as  a 
member  of  the  Executive  Committee. 

(This  motion  was  agreed  to.) 

The  session  then  adjourned  at  4.37  P.  M. 


FOURTH  INTERNATIONAL  SANITARY  CONFERENCE.  71 


SIXTH  DAY— FRIDAY,  DECEMBER  31,  1909. 
Morning  Session. 

The  Conference  was  called  to  order  by  President  Ulloa  at  9.35  a.  m., 
the  following  Delegates  being  present:  Amador,  Quifiones,  Castro^ 
Roberts,  Vial,  Amesse,  Wyman,  von  Ezdorf,  Liceaga,  Monjaras, 
Acosta,  Vasqiiez,  Porras,  Soto,  Rojas,  Duran,  Toledo,  Razetti,  and 
Ulloa. 

The  Secretary,  Dr.  Razetti,  read  the  Spanish  minutes  for  Decem- 
ber 30,  which  were  approved  without  discussion. 

The  Secretary,  Dr.  von  Ezdorf,  read  the  English  minutes  for  the 
morning  session  of  December  30,  which  were  also  approved  without 
discussion 

The  President.  I  have  the  pleasure  to  inform  the  Delegates  that 
we  have  among  us  Dr.  Manuel  Camilo  Vial,  Delegate  from  the  Re- 
public of  Chile,  whom  I  have  the  honor  to  introduce  to  this  assembly,, 
regretting  that  the  obstacles  he  encountered  during  his  voyage  should 
have  deprived  us  of  the  pleasure  of  his  company  during  the  previous 
sessions.  I  rejoice  at  his  arrival,  and  feel  sure  that  all  the  members 
of  tliis  assembly  will  welcome  him  as  he  deserves. 

Dr.  Vial  expressed  his  gratitude  to  the  President,  and  delivered  his 
credentials. 

The  President  referred  them  to  the  Committee  on  Credentials.  He 
then  stated  that  if  there  was  a  session  in  the  afternoon.  Dr.  Vial  could 
have  the  floor  to  present  his  report. 

The  Secretary,  Dr.  Razetti,  read  a  telegram  from  the  Minister  of 
Foreign  Affairs  of  Paraguay,  stating  that  that  Republic  will  conform 
to  the  conventions  so  far  adopted,  and  explaining  why  it  had  not 
been  able  to  send  a  representative. 

The  President  stated  that  the  next  subject  on  the  programme  was 
that  relating  to  the  forms  for  sanitary  documents  which  are  to  be  used 
by  the  nations  signatory  of  the  Sanitary  Convention  of  Washington. 

Dr.  Roberts.  I  have  here  a  model  that  I  want  to  submit  for  bills 
of  health.  This  is  one  of  the  most  important  forms,  because  it  enables 
one  to  know  the  conditions  of  a  ship.  This  model  is  the  same  one 
used  by  the  United  States  of  America  and  Cuba.  It  is  also  somewhat 
similar  to  that  used  in  Venezuela.  Small  additions  have  been  made  to 
it  to  the  end  of  furnishing  the  physician  who  may  examine  it  with  as 
exact  an  idea  as  possible  of  the  conditions  of  the  ship  to  which  it  refers. 

(He  then  delivered  the  models  referred  to  and  the  President  ordered 
that  they  be  submitted  to  the  respective  committee.  See  Appendix, 
page  110.) 

Dr.  Liceaga  stated  that  he  also  had  with  him  the  models  used  in 
Mexico,  and  begged  to  submit  them  to  the  consideration  of  the  Con- 
ference. 

(They  were  also  referred  to  the  respective  committee.) 

Dr.  Amesse  requested  the  Delegates  having  models  of  sanitary  docu- 


72  FOURTH   INTERNATIONAL   SANITARY   CONFERENCE. 

ments  to  pass  them  to  Dr.  Roberts,  Delegate  from  Cuba,  chairman  of 
Committee  on  Sanitary  Documents. 

The  President  requested  the  Delegates  from  Costa  Rica  to  give  to 
said  Committee  the  Consular  regulations  of  the  Republic,  wherein 
are  contained  the  models  of  the  documents  referred  to. 

The  members  of  the  Committee  on  Sanitary  Documents  were  re- 
quested to  convene  after  the  morning  session,  in  order  that  they  might 
submit  their  reports  in  the  afternoon  session. 

The  subject  relating  to  measures  against  diseases  not  included  in  the 
Sanitary  Convention  of  Washington  of  1905    was  then  taken  up. 

Dr.  Liceaga  read  a  paper  relative  to  means  of  preventing  the  intro- 
duction of  diseases. 

Dr.  Soto.  When  the  Delegation  of  Costa  Rica  presented  its  report, 
I  made  a  suggestion  relating  to  two  diseases  which  are  extremely  con- 
tagious, and  which  I  have  not  seen  among  those  included  in  the  Sani- 
tary Convention  of  Washington  as  transmissible  diseases.  I  refer  to 
hydrophobia  and  hydatid  cysts  of  the  liver. 

In  Costa  Rica  we  have  not  had  as  yet  any  cases  of  rabies,  nor  of 
that  terrible  scourge  known  as  hydatid  cysts  of  the  liver,  a  disease 
transmitted  by  dogs  infected  with  it ;  and  in  view  of  the  fact  that  there 
are  continuously  imported  to  our  country  from  abroad  high  pedigree 
dogs  for  breeding  purposes,  the  introduction  of  such  dogs  being  un- 
restricted, I  believe  it  is  high  time  to  prevent  the  introduction  into  the 
-country  of  infected  dogs  which  might  spread  among  us  those  terrible 
diseases,  thus  increasing  mortality. 

Therefore,  I  take  the  liberty  to  submit  to  the  consideration  of  the 
Conference  the  resolution  which  I  am  now  going  to  read.  (He  then 
read  the  proposition  that  appears  on  page  114  of  the  Appendix.) 

The  President  caused  the  above  proposition  to  be  referred  to  the 
Executive  Committee. 

Dr.  Castro.  Messrs.  Delegates :  with  reference  to  what  I  said  yester- 
day, regarding  the  diseases  not  included  in  the  Sanitary  Convention  of 
Washington,  and  the  disease  known  as  "Bilharziosis,"  and  believing 
that  it  is  now  in  order  to  submit  to  the  consideration  of  this  Conference 
whether  it  is  advisable  to  include  bilharziasis  in  the  said  list  of  con- 
tagious diseases,  I  beg  leave  to  dwell  upon  a  few  descriptive  details, 
because  my  attention  has  been  called  by  a  member  of  this  assembly  to 
the  fact  that  it  would  be  opportune  to  make  a  brief  statement  in  regard 
to  that  disease,  in  case  any  of  those  here  present  are  not  well  posted 
as  to  that  disease. 

Bilharziosis,  as  all  my  distinguished  colleagues  are  aware,  is  caused 
hy  a  parasite  known  as  distomum  hematohium,  and  was  discovered  in 
Egypt  1850  or  1860;  since  then  it  has  been  found  in  all  the  eastern 
slope  on  the  Mediterranean  Sea,  in  the  eastern  and  central  parts  of  the 
African  Continent,  Sudan  and  Uganda.  I  have  an  idea  that  it  has  also 
teen  found  in  Madagascar  and  in  the  Comores  Islands,  although  I  am 
not  sure,  because  I  have  not  been  able  to  find  the  necessary  data  to 
verify  that  information. 

The  parasite  is  thread-like,  and  cylindrical;  the  male  is  from  ten  to 
fifteen  millimeters  long,  and  the  female  a  little  longer,  about  twenty 
millimeters. 

The  infection  is  transmitted  by  means  of  the  eggs,  which  are  char- 


FOURTH  INTERNATIONAL  SANITARY  CONFERENCE.  73 

acteristic  in  this  parasite,  and  which  cannot  be  mistaken  for  those  of 
any  other.     Its  diagnosis  is,  therefore,  easy. 

Now,  then,  these  parasites,  which  produce  most  important  changes 
in  the  organism,  are  introduced  therein  by  means  of  drinking  water,  or 
by  means  of  vegetables  washed  in  infected  water.  The  parasite  in- 
fects particularly  the  hemorrhoidal,  rectal,  vesical  and  uterine  venous 
plexus ;  they  are  afterwards  also  found  in  the  portal  vein  and  mesen- 
teric and  splenic  ramification,  in  vena  cava,  in  the  liver,  the  lungs,, 
the  heart,  and  the  kidneys. 

In  Egypt  the  disease  is  very  common,  and,  although  it  does  not 
prevail  among  seventy-five  per  cent  of  the  population,  as  I  wrongly 
said  yesterday,  the  percentage  of  cases  does  reach  fifty  per  cent,  which 
is  indeed  an  enormous  rate. 

The  principal  importance  regarding  the  knowledge  of  this  disease 
does  not  lie  in  the  difficulties  of  prophylaxis — which  I  do  not  think 
would  be  very  difficult — but  in  the  seriousness  itself  of  the  disease,, 
because  it  is  an  almost  incurable  malady. 

In  Costa  Rica  there  has  only  been  recorded  one  single  case,  and 
the  Delegate  from  Cuba — in  which  Republic,  as  we  know,  are  very  good 
physicians  and  competent  bacteriologists — told  me  that  he  had  no  idea 
that  such  a  disease  occurs  there.  In  Costa  Rica  we  have  observed^ 
accidentally,  one  single  case,  which  has  enabled  us  to  know,  at  least, 
the  eggs  of  the  parasite.  That  case  arrived  in  Costa  Rica  from  Vene- 
zuela ;  at  least,  the  patient  said  that  he  was  born  and  had  lived  in  that 
country,  where  he  also  contracted  the  chronic  disease  of  which  he 
was  afflicted,  and  which  w^as  a  form  of  dysentery.  By  pure  accident,, 
when  the  feces  were  examined,  there  v/ere  found,  among  other  dififer- 
ent  species,  eggs  of  a  peculiar  shape  which  attracted  attention  and  made 
possible  the  recognition  of  the  disease. 

In  view  of  the  above,  it  seems  to  me  that  it  would  be  extremely  ad- 
visable— since  we  suspect  that  the  disease  in  question  exists  in  Vene- 
zuela, that  it  is  easily  diagnosed,  and  that,  on  the  other  hand,  the 
Delegate  from  Venezuela  told  us  a  few  days  ago  that  there  were  in 
that  country  about  four  thousand  deaths  annually,  on  account  of 
dysentery — to  determine  in  all  countries,  w^herever  it  be  possible,  how 
many  forms  of  dysentery  are  due  to  this  parasite. 

At  all  events,  it  is  necessary  to  prevent  that  disease  from  being- 
introduced  in  countries  where  it  is  yet  unknown;  to  this  end  I  am 
going  to  have  the  honor  to  read,  for  submission  to  this  learned  assem- 
bly, a  proposition  providing  that  bilharziasis  be  included  in  the  list  of 
diseases  the  admission  of  which  is  prohibited  by  the  Sanitary  Con- 
vention of  Washington. 

I  beg  to  submit  this  proposition,  together  with  my  esteemed  col- 
league. Dr.  Soto,  who  has  authorized  me  to  put  his  name  together 
with  mine  in  this  matter. 

I  said  that  the  danger  of  this  disease  does  not  depend  upon  the 
impossibility  of  preventing  transmission,  but  rather  of  upon  the  impos- 
sibility of  curing  it.  The  individuals  afflicted  with  this  dysentery,  or 
hematuria,  are  almost  doomed  to  perish,  because,  as  I  have  stated, 
it  is  an  almost  incurable  disease,  and  the  patients  live  a  pitiable 
existence. 

Therefore,  it  is  a  disease  against  which  we  should  protect  ourselves- 


74  FOURTH    INTERNATIONAL   SANITARY   CONFERENCE. 

in  the  countries  where  it  has  not  yet  been  introduced,  and  as  it  is  easy 
to  avoid  it,  it  seems  to  me  that  it  is  opportune  to  add  it  to  the  list  of 
the  diseases  the  admission  of  which  is  prohibited,  and  that  some  action 
should  be  taken  thereon.  (Dr.  Castro's  proposition  appears  on  page 
114  of  the  Appendix.) 

The  President.  This  proposition  will  be  referred  to  the  Executive 
Committee. 

Dr.  von  Ezdorf.  Mr.  President,  our  quarantine  regulations  include 
the  quarantining  of  three  other  diseases  that  have  not  been  mentioned 
previously  in  this  Conference;  typhus  fever,  smallpox  and  leprosy. 
With  regard  to  typhus  fever,  we  have  a  quarantine  of  12  days,  which, 
of  course,  means  that  if  typhus  fever  arrives  at  a  port  of  the  United 
States  on  board  a  vessel,  the  vessel  is  disinfected  and  detained  to  com- 
plete 12  days,  which  is  the  accepted  incubation  period  of  that  disease. 
In  regard  to  smallpox,  we  require  vaccination  or  proof  of  recent  suc- 
cessful vaccination,  and  if  certain  regulations  have  been  observed  on 
the  part  of  the  vessels,  the  vessels  are  not  detained,  but  the  case  is 
removed  and  the  vessel  allowed  to  proceed.  With  regard  to  leprosy, 
no  cases  of  leprosy  are  allowed  to  enter  the  United  States.  There  are 
other  diseases  that  interest  our  country  a  great  deal  and  on  which  a 
great  deal  of  study  and  work  is  being  done,  which  have  already  been 
mentioned  by  Surgeon-General  Wyman,  namely.  Pellagra,  Uncina- 
riasis, and  Tuberculosis.  I  should  like  to  propose  that  they  be  given 
consideration  in  regard  to  the  protection  of  our  countries  against  fur- 
ther spread  of  those  diseases. 

(Dr.  von  Ezdorf 's  remarks  were  translated  into  Spanish  by  the 
President,  for  the  benefit  of  the  Spanish  Delegates.) 

Dr.  Acosta.  In  answer  to  the  allusion  made  by  the  Delegate  from 
Nicaragua  regarding  the  existence  of  bilharziasis  in  Venezuela,  I  will 
say  that  neither  in  the  Vargas  hospital,  which  is  a  cosmopolitan  hospital, 
and  to  which  patients  from  all  parts  of  the  Republic  are  taken,  nor 
by  investigations  in  the  different  cases  of  dysentery,  microscopical 
studies  in  laboratories,  nor  by  examination  of  feces,  of  persons  dying 
of  dysentery,  have  I  been  able  to  ascertain  that  the  parasite  of  bil- 
harziasis was  ever  found  among  the  many  other  parasites  of  different 
kinds  occurring  in  the  cases  of  dysentery.  Therefore,  it  is  very  strange 
that  the  case  referred  to  by  Dr.  Castro  should  have  come  from  Vene- 
zuela ;  and  I  want  to  state  that  bilharziasis,  at  least,  is  not  common  in 
my  country  to  the  extent  of  constituting  danger  for  the  other  nations. 

Dr.  Castro  requested  the  floor  to  answer  Dr.  Acosta,  but 

The  President  called  the  attention  of  the  Delegate  to  the  fact  that 
the  subject  was  not  under  discussion,  and  stated  that  Dr.  Castro's 
resolution  would  be  submitted  to  the  Executive  Committee,  whose  re- 
port would  be  discussed  in  due  time.  He  also  stated  that  he  made 
this  remark  in  order  to  avoid  discussion  which  might  take  the  time 
that  was  necessary  for  transactions  that  have  to  be  carried  out. 

(Discussion  was  then  taken  up  of  the  sanitary  measures  that  should 
be  taken  against  venereal  diseases.) 

Dr.  Liceaga.  In  accordance  with  the  10th  clause  of  the  programme, 
the  Mexican  Delegation  is  going  to  read  a  paper  regarding  that  matter. 
(He  then  read  the  report  referred  to.) 

The  President.     I  call  the  attention  of  the  Delegates  to  the  fact 


FOURTH  INTERNATIONAL  SANITARY  CONFERENCE.  75 

that  although  the  provisional  programme  included  the  article  referred 
to  by  Dr.  Liceaga,  it  was  left  out  in  the  programme  of  this  Conference, 
because  venereal  diseases  are  of  a  local  character,  and  it  is  difficult  in 
practice  to  adopt  in  the  different  ports  of  entry  the  necessary  regula- 
tions to  prevent  their  introduction.  This  was  in  accordance  with  the 
opinion  of  several  of  the  Delegates. 

Dr.  Liceaga.  I  wish  to  make  an  explanation  of  the  reason  why  the 
Mexican  Delegation  presented  this  paper.  No.  10  of  the  provisional 
program  says:     (He  then  read  the  clause  referred  to.) 

We  received  this  programme  about  six  or  eight  months  ago,  and, 
naturally,  each  Delegation,  in  order  to  observe  conscientiously  all  the 
points  therein  contained,  was  obliged  to  present  the  reports  referred 
to  by  the  said  programme.  Therefore,  I  want  it  known  that,  whatever 
be  the  decision  taken  in  regard  to  the  subject,  the  Mexican  Delegation 
has  fulfilled  and  observed  the  letter  of  the  programme,  and  in  accord- 
ance therewith  presented  this  report. 

The  President.  I  request  all  the  Delegates  present  to  please  vote 
on  these  points,  whether  we  shall  leave  out  the  discussion  of  venereal 
diseases  or  include  it  in  the  program.  I  thought  we  were  not  going 
to  take  this  matter  up  and  had  planned  accordingly,  but  I  leave  it  to 
the  Delegates,  and  I  request  that  you  specify  whether  or  not  you 
desire  to  include  the  subject  in  the  program.  Those  in  favor  of 
the  motion — 

Dr.  Wyman.  What  is  the  motion? 

The  President.  That  we  shall  not  consider  the  subject  of  venereal 
diseases  at  this  Conference. 

Dr.  Liceaga  addressed  the  Conference  in  Spanish  on  the  subject. 

Dr.  Wyman.  Mr.  President,  it  is  true  that  subject  was  included  in 
the  provisional  program,  but  the  program  was  provisional,  and  we 
have  a  right  here,  if  we  so  vote,  to  exclude  this  from  the  Transactions. 
I  am  very  much  interested  in  the  report  that  Dr.  Liceaga  has  made, 
and  I  have  also  in  my  room  at  the  hotel  some  comments  of  the  same 
nature,  making  a  brief  report  from  the  United  States,  but  I  understood 
that  the  scheme  was  rather  that  we  should  not  have  this  subject  dis- 
cussed particularly  at  this  meeting  or  be  inscribed  in  the  proceedings  of 
this  Conference.  When  that  was  suggested  to  me  I  readily  acquiesced, 
because  I  think  the  subject  is  one  of  such  very  great  importance  that  we 
ought  to  give  it  at  some  future  Conference  very  special  attention,  and 
I  do  not  believe  that  any  of  us  are  prepared  to  thoroughly  discuss  that 
subject  at  the  present  time.  It  is  one  of  the  most  important  subjects 
before  the  people  of  the  world  to-day,  and  I  think  that  before  this 
Conference  goes  into  it  we  should  have  ample  notice  with  regard  to  it 
and  should  make  very  special  study  in  order  that  we  may  make  reason- 
able suggestions.  It  is  one  of  the  subjects  that  is  engaging  our  atten- 
tion in  the  United  States,  and  I  consider  it  an  unsolved  problem  how  to 
deal  with  it,  and  we  need  more  time  to  study  it  out.  But  it  is  just  as 
well  that  the  matter  has  been  brought  up  in  this  shape  at  this  Confer- 
ence, for  we  can  prepare  to  take  it  up  seriously  at  some  future  time. 
I  believe  it  would  be  unwise  to  attempt  to  handle  it  at  this  meeting,  and 
when  the  motion  is  put  I  shall  vote  to  defer  its  consideration. 

(The  President  repeated  Surgeon-General  Wyman's  remarks  in  the 
Spanish  language.) 


76  FOURTH    INTERNATIONAL   SANITARY   CONFERENCE. 

(A  vote  was  taken  and  it  was  decided  not  to  consider  the  subject  of 
venereal  disease  at  this  time.) 

Dr.  Liceaga.  Mr.  President,  I  would  like  to  know  as  to  what  this 
point  refers  to:  "Discussion  of  the  matters  related  with  the  Fourth 
Sanitary  Conference." 

The  President.  To  any  other  matter  which  may  be  included  in  the 
provisional  programme,  and  which  may  be  considered  in  this  Confer- 
ence, in  accordance  with  its  decisions. 

Dr.  Vial.  I  would  like  to  make  a  request  of  the  Conference.  In 
the  Canal  Zone  of  Panama,  under  the  control  of  the  Government  of 
the  United  States  of  America,  there  used  to  be  published  monthly  a 
paper  containing  statistics  of  all  the  diseases  occurring  in  the  Zone,. 
which  publication  is  of  great  interest  for  all  the  Republics  that  main- 
tain relations  with  that  region.  As  this  publication  has  been  suspended, 
undoubtedly  by  virtue  of  the  department  in  Washington,  I  take  the 
liberty  to  request  the  President  of  the  Conference  that,  if  he  has  no 
objection,  he  request,  in  behalf  of  this  assembly,  that  the  said  publica- 
tion be  again  issued,  because,  as  I  have  said,  that  statistical  bulletin  is 
really  interesting  for  us. 

If  all  the  Delegates  here  present  share  in  my  opinion,  I  would  ask 
the  Chair  to  make  a  request  to  that  end. 

The  President  offered  to  do  so  through  the  Chairman  of  the  Inter- 
national Sanitary  Bureau  of  Washington,  Dr.  Wyman,  if  there  was  no 
objection  to  it.  Referring  to  the  subject  of  diseases,  he  stated  that  if 
there  was  any  Delegate  who  desired  to  move  that  it  be  taken  into 
consideration  in  the  next  Conference,  or  in  a  subsequent  one,  he  could' 
do  so. 

Dr.  Liceaga.  I  am  glad  to  hear  the  suggestion  made  by  the  Presi- 
dent, because  if  there  are  any  diseases,  affecting  social  hygiene,  of 
extraordinary  importance,  they  are  those  included  under  the  name  of 
venereal  diseases.  Alcoholism,  tuberculosis,  and  syphilis  constitute 
the  three  capital  plagues  of  humanity;  and  if  these  three  sub- 
jects ought  not  to  be  taken  into  consideration  by  this  Conference,  1 
do  not  know  to  what  other  subjects  a  greater  importance  could  be  at- 
tached. 

Therefore,  I  am  of  the  opinion  that  the  Fifth  International  Sanitary 
Conference  of  the  American  Republics  be  asked  to  take  up  all  subjects 
that  may  belong  to  social  hygiene,  especially  in  regard  to  the  venereal- 
syphilitic  diseases.     And  I  make  a  motion  to  that  end. 

The  President.  I  second,  with  great  pleasure,  the  motion  of  the 
Delegate  from  Mexico,  my  esteemed  colleague  and  teacher,  Dr. 
Liceaga.  I  have  always  taken  a  deep  interest  in  matters  relating  to 
venereal  diseases,  and  with  this  respect  I  will  mention  a  set  of  regula- 
tions on  venereal  prophylaxis  which  I  prepared  when  I  was  a  member 
of  the  Cabinet  of  President  Iglesias,  which  regulations  were  carried 
out  with  the  best  results. 

(A  vote  was  taken  on  the  motion,  which  was  carried.) 

The  President.  We  are  going  to  have  a  session  of  the  Executive 
Committee,  and  I  desire  that  the  gentlemen  who  are  on  that  Com- 
mittee will  meet  together  in  the  Secretary's  office  to  dispose  of  the 
pending  matters.     The  session  is  adjourned  for  that  purpose. 

The  Conference  then  took  a  recess,  at  10.30  A.  M.,  until  2  P.  M. 


FOURTH   INTERNATIONAL  SANITARY  CONFERENCE.  77 

Afternoon  Session. 

The  Conference  was  called  to  order  by  Dr.  Ulloa  at  2.40  p.  m.,  the 
following  Delegates  being  present:  Doctors  Quinones,  Castro,  Ama- 
dor, Vial,  Amesse,  Liceaga,  Monjaras,  Acosta,  Vasquez,  Soto,  Rojas, 
Toledo,  Razetti,  Ulloa,  von  Ezdorf,  Roberts,  and  Porras. 

The  English  minutes  for  the  afternoon  session  of  December  30th 
were  read  and  approved. 

The  President.  The  Delegate  from  Chile,  Dr.  Vial,  has  the  floor 
for  the  purpose  of  reading  his  report. 

Dr.  Vial.  Before  commencing,  the  Delegate  of  the  Republic  of 
Chile  sends  his  cordial  greetings  to  the  Delegates  of  the  sister  Re- 
publics here  represented,  and  especially  to  those  of  the  Republic  of 
Costa  Rica,  who  so  hospitably  have  received  us. 

(He  then  made  a  resume  of  the  report  which  appears  on  page  119 
of  the  Appendix.) 

The  President.  The  Delegate  from  Chile  has  again  the  floor  for 
the  purpose  of  presenting  the  names  of  three  physicians,  on  the  part 
of  Chile,  for  membership  in  the  International  Committee  mentioned  in 
the  provisional  programme. 

Dr.  Vial.  I  beg  to  present,  for  that  purpose,  the  following  names: 
Dr.  Ricardo  Davila  Boza,  the  Director  of  the  Institute  of  Hygiene ; 
Dr.  Lucio  Cordoba,  Secretary  of  the  Supreme  Council  of  Hygiene ; 
and  Dr.  Pedro  Lautaro  Ferrer,  Sanitary  Inspector  of  the  Republic. 

The  President.  If  the  members  of  the  Committees  have  no  report 
to  present,  in  order  to  gain  time  I  will  open  the  discussion  in  regard 
to  the  11th  clause. 

In  regard  to  this  subject,  I  informed  the  Conference  that  the 
International  Sanitary  Bureau  of  Washington  had  sent  a  commu- 
nication to  that  of  Paris,  requesting  it  to  take  into  consideration  the 
recommendation  made  by  the  Third  Conference  of  Mexico,  but  when 
I  left  the  United  States,  according  to  what  Dr.  Wyman  told  me,  no 
answer  had  as  yet  been  received.  Do  the  delegates  wish  that  further 
action  be  taken,  or  do  they  think  it  better  to  wait  for  the  answer? 

Dr.  Liceaga.  This  is  a  matter  of  great  interest,  and  if  no  answer 
has  been  received,  I  think  it  very  advisable  that  steps  be  taken,  both 
by  the  Conference  that  will  take  place  next  year,  as  well  as  by  the 
International  Bureau  of  American  Republics,  to  that  end. 

The  President.  I  think  that  in  order  to  save  time  we  should  take 
a  vote  on  the  motion  of  the  Delegate  from  Mexico,  without  submitting 
it  to  the  respective  committee. 

(The  vote  was  taken  and  the  motion  carried.) 

Dr.  Rojas  said  that  in  the  last  session  he  made  a  motion  to  the  effect 
that  the  Conference  appoint  a  committee  charged  with  the  preparation 
of  a  pamphlet  against  malaria,  for  submission  to  the  next  International 
Conference. 

The  President  stated  that  that  proposition  had  been  referred  to 
the  Executive  Committee,  which  would  report  upon  it.  He  then  said 
that  the  Executive  Committee  was  not  yet  ready  to  present  its  report ; 
that  there  were  some  matters  that  had  to  be  studied,  and  that  its  report 
would  be  ready  for  submission  on  the  session  of  Monday.  He  re- 
minded the  Delegates  that  it  was  in  order  in  that  session  to  set  the 


78  FOURTH    INTERNATIONAL   SANITARY   CONFERENCE. 

place  in  which  the  Fifth  International  Sanitary  Conference  of  the 
American  Republics  should  be  held;  that  in  that  same  session  the 
President  of  that  Conference  should  be  elected,  as  well  as  the  members 
of  the  International  Sanitary  Bureaus  of  Washington  and  Montevideo. 
He  also  said  that  in  the  closing  session  one  member  of  the  different 
delegations  would  make  a  brief  address,  to  be  answered  by  the  Presi- 
dent, thus  adjourning  the  Conference. 

The  President  also  stated  that,  in  order  to  give  the  committees 
time  for  their  deliberations,  the  session  was  going  to  be  closed,  re- 
minding the  Delegates  before  then  that  at  9  o'clock  would  take  place 
the  ball  given  by  the  society  of  San  Jose  in  honor  of  the  Conference. 

He  then  asked  the  Delegates  if  any  one  of  them  wished  to  take  the 
floor,  and  reminded  them  that  the  official  call  on  the  President  of  the 
Republic  would  take  place  at  one  o'clock  P.  M.  of  the  next  day. 

(The  Conference  then  adjourned,  at  3.30  P.  M.,  until  Monday, 
January  3d.) 


FOURTH  INTERNATIONAL  SANITARY  CONFERENCE.  79 


SEVENTH  DAY— MONDAY,  JANUARY  3,  1910. 
Morning  Session. 

The  Conference  was  called  to  order  by  Dr.  Ulloa  at  10  A.  M.,  all 
the  delegates  being  present. 

The  Spanish  minutes  of  the  morning  session  of  December  31st  were 
read  and  approved. 

The  English  minutes  of  the  morning  session  of  December  31st  were 
also  read  and  approved. 

Then  the  Spanish  and  English  minutes  of  the  afternoon  session  of 
December  31st  were  likewise  read  and  approved. 

The  President.  I  regret  to  inform  the  Conference  that  Dr.  Ama- 
dor has  been  compelled  to  withdraw  from  the  session  because  he  is 
not  feeling  well,  and  has  requested  the  Chair  to  read  the  list  of  the 
physicians  whose  appointment  he  recommends  for  membership  in 
the  International  Committee,  on  the  part  of  Colombia.  Those  names 
are  the  following:  Dr.  J.  M.  Lombana  Banetti ;  Dr.  Ricardo  Amaya 
Arias ;  Dr.  Juan  David  Herrera. 

At  the  same  time,  I  have  the  pleasure  to  announce  to  the  Confer- 
ence that  we  have  among  us  this  morning  Dr.  Victor  C.  Vaughan, 
Assistant  Professor  of  the  Detroit  Medical  College ;  he  is  the  son  of 
Dr.  Victor  C.  Vaughan,  Dean,  Department  of  Medicine  and  Surgery, 
of  the  University  of  Michigan,  and  member  of  the  Advisory  Board 
of  the  Hygienic  Laboratory.  It  is  with  pleasure  that  we  extend  to 
Dr.  Vaughan  the  privileges  of  the  floor. 

I  now  beg  to  submit  the  report  of  the  Executive  Committee,  which 
is  as  follows : 

Your  Executive  Committee,  after  carefully  studying  the  reports 
presented  by  the  different  committees  appointed  to  pass  upon  the 
propositions  submitted  to  the  consideration  of  this  Conference,  begs 
to  make  the  following  recommendations,  requesting  that  in  sending 
them  to  the  respective  Governments  emphasis  be  laid  on  the  import- 
ance of  executing  them  faithfully  and  as  soon  as  possible: 

I.  With  respect  to  bilharziosis,  hydrophobia,  leprosy,  typhus  fever,  ankylosto- 
miasis, etc.,  this  committee  suggests  that  recommendations  be  limited  to  request- 
ing the  various  governments  to  take  those  measures  of  protection  which  they 
believe  necessary. 

II.  (a)  To  recommend  especially  to  the  various  governments  that  they  employ 
all  possible  means  at  their  disposal  to  secure  the  effective  sanitation  of  seaports, 
to  the  end  that  the  introduction  of  plague,  cholera,  and  yellow  fever  may  be 
prevented,  and  in  the  event  that  a  case  of  either  of  these  diseases  reaches  a  port 
that  it  be  promptly  isolated  and  measures  taken  to  prevent  its  spread. 

(b)  To  recommend  special  ordinances  for  the  proper  construction  of  rat-proof 
buildings,  especially  those  designed  for  the  storage  of  foodstuffs,  such  as  markets, 
granaries,  abattoirs,  stables,  etc. 

(c)  To  make  obligatory  the  use  of  galvanized-iron  garbage  cans  with  tight- 
fitting  covers  for  the  reception  of  refuse  from  houses,  and  to  arrange  for  the 
daily  disposal  of  such  refuse. 


80  FOURTH    INTERNATIONAL   SANITARY   CONFERENCE. 

(d)  That  properly  equipped  laboratories  be  provided  at  all  seaports  where  the 
periodical  examination  of  rats  may  be  made  so  that  plague  can  be  apprehended 
before  its  appearance  in  human  beings. 

(e)  That  the  crusade  against  the  mosquitoes,  stcgomyia  calopus  and  anopheles,. 
be  carried  on  vigorously  along  lines  which  have  been  shown  to  bring  the 
best  results. 

(The  above  resolutions  were  approved  without  discussion.) 
(The  following  resohition  (third),  which  comprises  paragraphs  a,, 
b,  c,  d,  and  e,  was  passed  in  compHance  with  the  second  recominenda- 
tion  of  the  Third  International  Conference  of  the  American  Republics, 
held  in  Rio  de  Janeiro  in  August,  1906,  which  reads  as  follows:  "11. 
The  adoption  of  measures  intended  to  obtain  the  sanitation  of  the 
cities  and  especially  of  the  ports,  as  well  as  to  obtain  as  far  as  possible 
a  better  knowledge  and  a  better  observance  of  hygienic  and  sanitary 
principles.") 

III.  (a)  That  careful  statistics  on  population,  morbidity,  and  mortality  be 
kept  at  every  port,  such  data  to  be  compiled  at  regular  intervals  of  not  more 
than  one  month  and  also  annually. 

(b)  Every  port  should  be  provided  with  a  proper  system  of  sewerage,  an 
adequate  supply  of  pure  water,  and  paved  streets. 

(c)  That  all  habitations  be  constructed  with  a  view  to  furnishing  fresh  air 
and  sunlight  sufficient  to  maintain  the  health  and  vigor  of  the  inmates,  and  that 
the  character  of  the  construction  shall  conform  to  local  conditions. 

(d)  That  in  every  port  there  shall  be  a  sanitary  authority  clothed  with  ample 
power  to  vigorously  enforce  sanitary  ordinances. 

(e)  That  it  be  made  obligatory  in  schools  to  furnish  instruction  in  the  ele- 
mentary principles  of  hygiene  and  sanitation.  This  instruction  should  be  objec- 
tive, or  by  means  of  the  publication  of  simple  rules. 

(The  third  resolution  being  under  discussion,  the  Delegate  from 
Mexico,  Dr.  Liceaga,  said,  with  respect  to  paragraph  (e),  that  he 
thought  it  advisable  that  the  phrase  "or  both"  should  be  added  at  the 
end  of  such  paragraph,  because  said  recommendation  related  to  what 
might  be  made  effective,  and  as  it  was  especially  intended  for  small 
ports,  if  objective  instruction  could  not  be  provided  for,  it  would  have 
to  be  by  means  of  rules.) 

(The  addition  was  made  as  proposed  by  Dr.  Liceaga,  and  the  third 
resolution  was  thus  approved.) 

IV.  (a)  That  it  is  the  duty  of  owners  and  masters  of  vessels  to  rid  their  ves- 
sels of  rats  and  to  use  all  possible  means  to  keep  them  free  therefrom. 

(b)  That  this  should  be  accomplished  by  the  periodical  fumigation  of  holds  of 
vessels  with  sulphur  gas  at  periods  of  from  three  to  six  months  and  at  times 
when  advantage  may  be  taken  of  the  vessels  being  free  from  cargo  or  laid  up 
for  repairs;  and  at  all  other  times  vigilance  should  be  exercised  by  the  masters 
for  the  destruction  of  rats  by  such  other  means  as  they  deem  most  effective. 

This  resolution  was  passed. 

V.  (a)  That  no  person  be  allowed  to  em1)ark  who  is  suffering  from  a  quaran- 
tinable  disease,  or  from  scarlet  fever,  measles,  diphtheria,  or  any  other  com- 
municable disease. 

(b)  For  permitting  the  embarkation  of  passengers  and  crew  who  have  been 
presumably  exposed  to  infection  where  the  above-mentioned  diseases  exist  there 
should  be  observed  at  the  port  of  embarkation  the  following  requirements : 

1.  Cholera,  five  days'  observation  or  surveillance;  disinfection  of  baggage. 

2.  Smallpox  in  epidemic  form,  vaccination  or  other  evidence  of  immunity. 

3.  Typhus  fever  in  epidemic  form,  twelve  days'  detention  or  observation ;  dis- 
infection of  baggage.  ,.  .    ,      . 

4.  Plague,  seven  days'  detention  or  surveillance ;   dismfection  of  baggage. 


FOURTH   INTERNATIONAL  SANITARY  CONFERENCE.  81 

The  President.     I  think  it  should  be  five  days. 

Dr.  Liceaga.  The  above  resolution  which  prescribes  seven  days 
for  observation  of  plague  is  inconsistent  with  the  Sanitary  Convention 
of  Washington,  which  establishes  five  days  only,  and  that  Convention 
is  a  universal  law. 

The  President.  On  my  part,  I  have  followed  the  decision  of  the 
respective  committee.     In  this  respect  all  that  I  have  done  is  to  copy. 

Dr.  Liceaga.  How  is  it  possible  that  a  resolution  passed  by  this 
Conference  should  have  greater  force  than  a  pact  approved  by  the 
Governments  and  legislatures  of  the  nations? 

The  President.  Dr.  Liceaga  objects  to  this  seven  days'  observa- 
tion in  the  case  of  bubonic  plague,  because  the  Convention  of  Wash- 
ington appoints  five  days  for  this  observation.  Shall  we  change  the 
period  ? 

Dr.  Wyman.  I  do  not  think,  Mr.  President,  it  would  be  advisable 
for  us  to  attempt  to  change  the  Convention,  but  if  each  country  should 
think  seven  days  necessary  instead  of  five,  I  believe  each  country  would 
impose  seven  days  under  some  general  clause  permitting  it ;  but  it  would 
be  inadvisable  at  this  Conference  to  make  a  change  even  apparently 
contrary  to  the  previous  agreement  which  has  been  made.  In  case  a 
great  danger  should  threaten  any  country,  safety  would  be  the  first 
consideration.  But  it  would  be  inadvisable  for  this  Conference  to 
formally  abrogate  what  has  been  agreed  upon  between  the  different 
Republics. 

(The  President  translated  the  remarks  of  Surgeon-General  Wyman 
into  Spanish.) 

Dr.  Wyman.  I  wish  further  to  say,  Mr.  President,  in  explanation 
of  my  remarks,  while  I  was  on  the  committee  and  passed  upon  the 
resolution,  I  do  not  recall  that  that  matter  was  brought  to  our  atten- 
tion at  all.  It  was  not  discussed  in  the  Executive  Committee.  I  do 
not  know  how  it  escaped  us. 

The  President.  It  appears  in  this  report  of  the  Committee  on 
Protective  Measures  for  Passengers,  signed  by  Doctors  Duran,  Soto, 
von  Ezdorf,  Acosta,  Toledo  and  Ouifiones. 

Dr.  Wyman.  I  see  that  one  of  the  representatives  of  the  United 
States  was  on  that  committee  and  knew  about  it,  and  I  recall  now  that 
he  told  me  it  was  about  what  we  had  in  our  regulations. 

The  President.  I  remember  that  he  submitted  it.  Of  course,  I 
will  have  it  translated  into  Spanish.  I  only  had  the  English  copy ;  I 
did  not  have  the  Spanish  copy. 

Dr.  Wyman.  I  was  not  aware  at  the  time  that  there  was  anything 
in  there  that  was  contrary  to  the  Convention.  How  would  it  do  to 
leave  the  days  blank? 

The  President.  I  think  that  Dr.  Liceaga  is  right,  because  if  it 
is  in  the  Convention  we  should  put  it  down  as  it  is  in  the  Conven- 
tion, five  days ;  that  is  really  the  constitutional  law  for  us  in  this 
matter.  That  interpretation  of  Article  IX  will  leave  ample  ground 
for  the  countries  to  protect  themselves,  because  it  refers  to  bubonic 
plague  and  yellow  fever,  and  that  leaves  enough  latitude  there  for  the 
countries  to  protect  themselves  in  case  it  should  be  necessary. 

Dr.  Wyman.  If  I  had  considered  the  matter  carefully  I  think  I 
would  have  avoided  reference  to  that.     It  seems  that  our  regulations 


82  FOURTH   INTERNATIONAL   SANITARY   CONFERENCE. 

require  seven  days,  and  I  didn't  appreciate  that  it  was  more  than  the 
agreement.  It  may  be  that  there  is  some  modifying  clause  that  would 
not  make  our  regulations  inconsistent.  I  am  surprised  that  our  regu- 
lations appear  to  be  contrary  to  the  agreement,  because  I  was  very 
particular  when  that  agreement  was  framed  in  Washington  to  see 
that  our  own  regulations  conformed  to  the  agreement  and  that  the 
agreement  conformed  to  the  practices  that  we  had  established;  and 
I  am  surprised  to  find  that  there  is  a  difference,  and  it  seems  to  me 
that  there  must  be  some  qualifying  clause  somewhere  which  would 
make  a  practical  correspondence  between  these  regulations  of  seven 
days  and  the  period  as  required  by  the  agreement. 

Dr.  Liceaga.  I  believe  it  would  be  better  not  to  mention  any  period 
of  time  and  to  substitute  the  following  paragraph  for  the  one  in 
question:  "That  the  period  of  observation  which  should  be  fixed  for 
bubonic  plague  be  made  again  subject  of  experimental  and  scientific 
study." 

Dr.  von  Ezdorf.  Mr.  President,  it  appears  to  me  that  under  Ar- 
ticle IX  reference  is  made  to  an  infected  area  regarding  plague^ 
cholera  and  yellow  fever.  Under  Article  XX  it  says:  "A  ship  is 
considered  as  suspected  on  board  of  which  there  have  been  a  case 
or  cases  of  plague  or  cholera  at  the  time  of  departure  or  during  the 
voyage,  but  no  new  case  within  seven  days."  Now  this  refers  to- 
passengers  embarking  at  ports  at  which  plague  prevails,  so  I  do  not 
see  that  it  appears  here  that  five  days  are  held  to  be  the  incubative 
period  for  the  disease  or  that  it  should  be  restricted  to  exactly  five 
days. 

The  seven  days  mentioned  in  our  resolution,  therefore,  conforms  to^ 
Article  XX  of  the  Convention. 

Dr.  Wyman.  What  are  we  talking  about,  Mr.  President;  restric- 
tions upon  vessels  or  those  to  be  imposed  upon  passengers? 

The  President.     The  passengers. 

Dr.  Wyman.  Well,  what  does  the  agreement  refer  to,  vessels  or 
passengers  embarking  on  vessels? 

The  President.     That  says  passengers  on  board  vessels. 

Dr.  Wyman.     It  is  the  same  thing,  then. 

The  President.  Yes,  sir,  but  they  embark — this  resolution  refers 
to  the  protection  of  passengers  on  ships  that  might  contain  passengers- 
who  have  been  exposed  to  the  diseases  mentioned  here. 

Dr.  Wyman.  How  would  it  do  to  recommit  that  to  the  com- 
mittee, to  be  reported  on  this  afternoon? 

The  President.  It  is  only  one  point,  and  I  do  not  see  why  we 
cannot  come  to  an  agreement  of  some  kind  about  it. 

Dr.  Wyman.     Can't  we  strike  out  the  clause  altogether? 

The  Pre;sident.  We  must  say  something  about  bubonic  plague; 
how  are  we  going  to  leave  that  out? 

Dr.  von  Ezdorf.  I  should  like  to  know  from  Dr.  Liceaga  where  in 
the  Convention  it  stipulates  that  five  days,  or  no  more  than  five  days^ 
should  be  looked  upon  as  the  period  of  observation  for  plague? 

Dr.  Liceaga.  I  think  it  is  in  Article  IX  of  the  Convention  of 
Washington. 

Dr.  von  Ezdorf.  Article  IX  refers  to  the  area  of  infection.  As  I 
called  attention  to  just  now.  Article  XX — if  Dr.  Liceaga  will  read 


FOURTH  INTERNATIONAL  SANITARY  CONFERENCE.  83 

Article  XX  in  Section  III  it  would  appear  as  though  we  were  recog- 
nizing seven  days  as  being  the  incubation  period  for  that  disease. 

Dr.  Wyman.  Mr.  President,  according  to  this  book  (indicating) 
I  do  not  think  that  Dr.  Liceaga's  contention  holds  good  that  it  declares 
five  days  to  be  the  period  under  Article  IX. 

I  do  not  see  that  there  is  any  such  declaration.  ''Article  IX.  *  *  * 
First,  that  there  has  been  neither  a  death  nor  a  new  case  of  plague  or 
cholera  for  five  days  after  isolation,  death,  or  cure  of  the  last  plague 
or  cholera  case."  That  is  true,  but  that  refers  to  infected  areas  and 
does  not  establish  the  period  of  incubation  for  the  disease,  so  that  I 
think,  as  they  have  got  it  in  there,  that  it  is  all  right — seven  days. 

(Surgeon-General  Wyman's  remarks  were  translated  into  Spanish 
by  the  President.) 

Dr.  Wyman.  If  you  will  allow  me — under  Article  XX,  it  says: 
*A  ship  is  considered  as  suspected  on  board  of  which  there  have  been 
a  case  or  cases  of  plague  or  cholera  at  the  time  of  departure  or  during 
the  vo)'^age;  but  no  new  case  within  seven  days."  So  I  think  that 
is  all  right,  Mr.  President. 

The  President.     We  shall  now  take  a  vote  upon  this  point. 

(A  vote  was  taken  and  the  section  was  approved  just  as  it  was. 
read. ) 

The  President.     The  next  paragraph  is  as  follows: 

5.  Yellow  fever,  six  days'  detention  or  surveillance;  or  immunity. 

The  President.  The  original  said  "five  days"  and  I  changed  it,, 
making  it  "six"  instead.  If  you  so  desire,  we  shall  make  it  "five"" 
again. 

(A  vote  was  taken  and  the  paragraph  approved  as  read.) 

(c)  Thorough  cleaning  of  all  portions  of  the  vessel  and  prompt 
isolation  of  all  cases  of  sickness  which  may  occur  on  board. 

(A  vote  was  taken  and  the  paragraph  approved.) 

VI.  Your  Executive  Committee  recommends  that  Article  IX  of  the  Conven- 
tion of  Washington  be  interpreted  as  follows : 

Article  IX.  In  order  that  a  locality  be  considered  free  of  contagion,  it  wilil 
be  necessary  to  furnish  official  proof  to  the  satisfaction  of  the  interested  party. 

First.  That  there  have  been  no  deaths  nor  new  cases  of  plague  or  cholera 
for  five  days  after  the  isolation,  death,  or  discharge  of  the  last  case  of  plague 
or  cholera;  in  the  case  of  yellow  fever  the  period  shall  be  eighteen  days,  but 
each  Government  reserves  the  right  to  prolong  this  period  against  those  coun- 
tries where  the  measures  for  the  isolation  of  cases,  the  destruction  of  mosquitoes^ 
and  the  disinfection  of  food  are  not  observed. 

Second.  That  all  measures  of  disinfection  have  been  applied,  and  in  treating 
of  plague  cases  that  there  have  been  carried  out  all  measures  for  the  destruction 
of  rats,  and  in  the  case  of  yellow  fever  that  the  proper  measures  have  been 
taken  against  mosquitoes. 

Dr.  Razetti.  I  believe  that  in  an  official  document  we  should  not 
say  "bubonic  plague."  The  disease  is  called  "plague,"  simply,  and  the 
word  "bubonic"  expresses  one  of  its  various  forms.  In  our  docu- 
ments we  should  be  very  clear  as  regards  names,  and,  therefore,  I 
am  of  the  opinion  that  instead  of  "bubonic  plague"  it  be  made  to  read 
"plague,"  only. 

Dr.  Wyman.     Yes,  sir;  it  should  be  plague  without  the  "bubonic.^ 

The  President.     The  Convention  says  "Peste  Bubonica." 

Dr.  Wyman.     Does  it?    Well,  that  settles  it. 


84  FOURTH    INTERNATIONAL    SANITARY    CONFERENCE. 

Dr.  von  Ezdorf.  In  the  English  copy  it  says,  "plague,"  without 
the  word  "bubonic" ;  and  it  says  further  that  if  there  is  any  difference 
between  the  two  versions  that  the  English  version  shall  be  accepted. 

The  President.  I  would  like  to  have  the  opinion  of  the  Delegates 
upon  this  question.  (It  was  decided  in  favor  of  simply  "peste"  or 
-plague.") 

(The  sixth  resolution  was  passed  with  this  amendment.) 

VII.  To  recommend  that  the  Fifth  International  Sanitary  Convention  deter- 
mine what  constitutes  immunity  from  yellow  fever. 

Dr.  Lice  AG  a.  Although  it  may  seem  an  insignificant  point,  I  insist 
that  the  name  of  "Convention"  be  given  to  this  meeting  instead  of 
"Conference,"  because  some  resolutions  refer  to  the  next  "Convention" 
and  others  the  next  "Conference." 

I  believe  that  "Convention"  and  "Conference"  are  two  things  en- 
tirely different,  and  we  should  not  mistake  one  thing  for  another. 

It  seems  that  the  original  name  was  that  of  "Convention"  because 
these  meetings  were  originated  by  the  Conference  of  Mexico  of  1902, 
which  provided  very  clearly  that  they  should  be  called  "Conventions." 

A  Conference  is  a  meeting  which  discusses  political  and  commercial 
matters,  etc.,  and  a  Sanitary  Convention  deals  with  health  matters. 

Therefore,  if  we  do  not  make  this  point  clear  in  passing  the  resolu- 
tions it  would  be  impossible  to  know  if  they  refer  to  the  Conference 
of  Buenos  Aires  or  to  the  next  Sanitary  Convention. 

The  President.  I  do  not  agree  with  what  Dr.  Liceaga  has  just 
said,  because  when  we  say  "Sanitary  Conference"  it  is  understood  that 
it  refers  to  sanitary  matters;  other  Conferences  do  not  deal  with  sani- 
tary matters.  In  changing  the  word  "Conference"  we  have  had  in 
mind  that  "Conference"  means  one  thing  and  "Convention"  means 
another. 

I  am  going  to  read  the  definition  of  the  two  words  according  to 
the  dictionary. 

(The  President  read  the  definitions  referred  to  from  the  Dictionary 
of  the  Castilian  Language  by  the  Royal  Spanish  Academy,  pages  254 
and  265,  13th  Edition,  Madrid,  1899.) 

Therefore,  a  "Convention"  is  the  result  of  the  discussions  that  take 
place  in  a  "Conference" ;  that  is  why  we  call  "Convention  of  Washing- 
ton" that  which  we  signed  in  that  city  in  1905. 

"Conference,"  as  the  name  itself  indicates,  is  what  we  now  do  here ; 
we  are  discussing  for  the  purpose  of  resolving  something,  and  that 
which  we  resolve  is  part  of  the  Convention  we  all  approve. 

Therefore,  I  am  of  the  opinion  that  the  name  of  "Conference"  be 
not  changed  to  that  of  "Convention." 

Dr.  Liceaga.  I  request  the  Chair  that  my  point  of  view  in  this 
matter  be  recorded  in  the  proceedings. 

The  President.  I  do  not  insist  that  my  opinion  should  prevail. 
In  all  the  pu.blications  I  have  said  "Sanitary  Conference" ;  but  I  will 
submit  the  question  to  the  consideration  of  the  assembly  so  that  it 
may  take  a  vote  thereon. 

(A  vote  was  taken  on  the  question  as  to  whether  the  name  of 
"Sanitary  Conference"  or  "Sanitary  Convention"  is  the  proper  one, 
and  by  a  majority  of  votes  it  was  decided  that  the  name  should  be 
"International  Sanitary  Conference  of  the  American  Republics.") 


FOURTH  INTERNATIONAL  SANITARY  CONFERliNCE.  85 

The  reading  of  the  report  of  the  Executive  Committee  was  con- 
tinued as  follows : 

VIII.  To  recommend  to  the  Governments  here  represented  the  great  import- 
ance of  distributing,  in  all  possible  ways,  instructions  as  to  the  best  measures 
by  which  people  may  protect  themselves  against  malaria  and  tuberculosis,  espe- 
cially by  the  publication  of  rules  to  control  these  diseases  and  by  making  it 
obligatory  on  the  part  of  employers  of  labor  to  supply  such  rules  and  to  require 
their  observance  by  their  employees. 

(This  resolution  was  passed  without  discussion.) 

IX.  That  the  countries  here  represented  adopt  the  models  of  sanitary  docu- 
ments herewith  presented.     (See  page  110.) 

(This  resolution  was  passed  without  discussion.) 

Dr.  Razetti.  Mr.  President,  I  wish  to  know  if  it  is  possible  to 
add  another  resolution? 

The  President.     If  the  assembly  so  decides,  I  have  no  objection. 

Dr.  Razetti.  I  am  going  to  read  a  resolution  and  let  the  assembly 
decide  if  it  should  be  added  to  the  others  which  have  just  been  read.  It 
is  a  thing  that  could  be  admitted  without  discussion  as  a  good  measure 
for  some  small  countries  as  mine,  it  being  also  a  good  one  for  the 
future  of  public  health  and  the  study  of  infectious  diseases.  It  is  as 
follows : 

For  the  purpose  of  perfecting  in  the  tropics  the  knowledge  of  infectious 
diseases  and  of  giving  medical  science  the  reallj'  scientific  basis  that  it  has 
attained  in  the  more  advanced  countries,  the  Conference  recommends  to  the 
Governments  of  the  American  Republics  that,  even  though  they  may  not  possess 
those  elements  of  progress,  they  give  their  efficient  support  to  all  enterprises 
tending  to  provide  the  Republics  with  true  specialists  on  parasitology  and  patho- 
logical anatomy. 

Likewise,  it  recommends  the  said  Governments  to  favor  in  the  important 
ports  and  cities  the  creation  of  laboratories  where  not  only  the  necessary 
diagnosis  for  the  compliance  v.'ith  the  provisions  of  sanitary  conferences  should 
be  made,  but  also  where  original  investigations  may  be  made  of  such  problems 
of  tropical  and  general  pathology  as  the  sanitary  authorities  may  deem  ad- 
visable. 

The  principal  object  of  this  proposition  that  I  make  in  the  name  of 
Drs.  Castro,  Cervantes,  and  Acosta.  and  in  my  own,  is  that  a  resolution 
of  this  kind  passed  by  our  Conference  will  have  a  powerful  influence 
on  the  Governments  of  the  small  Republics  to  encourage  the  study 
of  such  diseases  as  prevail  in  otir  countries,  which  are  of  great  interest 
to  international  health;  because  by  this  means  we  will  be  enabled  to 
discover  many  diseases  and  to  know  better  how  to  treat  them  and 
prevent  them,  since  this  study  is  not  sufficiently  advanced  in  all  the 
countries  of  Latin-America.  This,  of  course,  does  not  refer  to  the 
United  States  of  North  America,  nor  to  other  countries  that  are  pro- 
vided with  all  sorts  of  means,  but  it  does  refer  to  us. 

Dr.  Liceaga.  I  second  the  motion  of  the  delegations  of  Nicaragua 
and  Venezuela  just  presented  by  Dr.  Razetti. 

Dr.  Castro.  Among  the  resolutions  read  by  the  President  there  is 
one  relating  to  the  creation  of  laboratories,  etc.,  and  I  think  that  our 
proposition  might  fit  in  exactly  that  resolution.  The  mere  fact  of  this 
proposition  having  been  presented  and  appearing  in  the  printed  pro- 
ceedings would  by  itself  have  a  great  value  in  causing  the  interested 
Governments  to  take  note  of  it. 


86  FOURTH    INTERNATIONAL   SANITARY   CONFERENCE. 

The  President.     Did  you  understand  the  motion? 

Dr.  Wyman.  I  think  that  is  the  same  motion  the  Doctor  read  me 
this  morning.  Of  course,  that  motion,  Mr.  President,  should  have 
been  offered  before  and  sent  to  the  Executive  Committee  to  be  passed 
upon,  but  it  struck  me,  as  I  read  the  motion,  that  it  is  a  very  proper 
one  and  probably  will  do  a  great  deal  of  good,  and  I  have  thought  that, 
this  being  the  desire  on  the  part  of  these  gentlemen  from  this  section 
that  we  should  yield  to  their  wishes  in  this  matter ;  and  I  move  you,. 
Mr.  President,  that  the  rule  by  which  it  goes  to  the  Executive  Com- 
mittee be  suspended,  and  that  we  pass  that  resolution ;  or  I  suppose 
the  motion  has  already  been  made  to  pass  it,  and  I  second  that  motion. 

The  President.  Yes,  the  motion  has  already  been  made,  but  your 
motion  is  all  right  to  dispense  with  its  going  to  the  Executive  Com- 
mittee.    I  second  your  motion. 

(The  motion  was  put  and  carried.) 

Dr.  Wyman.  Mr.  President,  if  there  is  nothing  immediate  before 
you,  I  would  like  to  inquire  whether  the  resolutions  written  in  English 
are  in  the  hands  of  the  English  Secretary  or  your  own?  There  were 
three  in  particular :  one  with  regard  to  destruction  of  rats  on  vessels ;: 
another  with  regard  to  the  regular  sanitation  of  ports,  and  the  other 
upon  special  sanitation  of  ports  with  regard  to  bubonic  plague  and 
yellow  fever.     Have  you  those  resolutions  ? 

The  President.  Yes.  I  propose  to  have  the  translation  made 
before  you  go. 

Dr.  Wyman.  Well,  I  do  not  need  the  translation ;  I  am  speaking 
of  resolutions  in  English  that  are  to  be  translated  into  Spanish.  I 
am  only  anxious  that  the  three  resolutions  shall  be  printed  in  the 
language  in  which  they  were  sent  in  so  far  as  the  English  is  concerned. 
You  would  not  translate  them  again  from  Spanish  into  English,  and 
use  the  text  of  the  translation? 

The  President.  Yes;  it  is  going  into  the  report  of  the  Confer- 
ence, and  I  was  going  to  say  that  I  intended  to  try  to  let  you  have  the 
resolutions  passed  to-day  so  that  you  can  all  inform  your  Governments 
when  you  make  your  reports.  I  am  going  to  try  to  have  copies  of 
all  the  minutes,  and  I  think  that  we  have  them  now  almost,  already.. 
My  idea  is  to  let  each  one  of  the  Delegates  take  a  copy  of  the  extract 
of  all  the  minutes,  including  those  of  to-day's  sessions,  as  well  as  a 
copy  of  the  resolutions  passed  in  this  session,  so  that  they  may  make 
a  full  report  thereon  upon  their  arrival  at  their  respective  countries,, 
without  waiting  for  the  publication  of  the  printed  proceedings,  the- 
preparation  of  which  will  take  some  time. 

Dr.  Quinones.  I  move  that  the  resolutions  be  also  published  in: 
English  in  the  Spanish  edition. 

The  President.  That  would  not  be  practicable  or  feasible;  it 
would  be  necessary  to  change  the  method  of  publication.  Each  Dele- 
gate will  receive  both  the  Spanish  and  English  editions. 

If  there  is  no  other  matter  to  be  discussed  I  beg  to  submit  to  the 
consideration  of  the  Conference  the  following  resolution: 

X.  To  recommend  to  the  Governments  represented  that  for  future  sanitary 
conferences  there  be  nominated  delegates  who  have  assisted  at  previous  con- 
ferences ;  and  when  the  delegations  are  composed  of  more  than  one  member,  that 
one  of  them  shall  have  assisted  at  a  previous  conference,  or  that  in  any  case 
the  delegates  shall  be  sanitary  authorities  in  their  respective  countries. 


FOURTH  INTERNATIONAL  SANITARY  CONFERKNCK.  87 

Dr.  Quinones.     I  second  the  motion  in  every  respect. 

Dr.  Wyman.  I  think,  Mr.  President,  that  resolution  should  be  so 
worded  as  not  to  discourage  the  sending  of  Delegates,  especially  from 
Republics  which  had  no  one  who  had  been  at  previous  Conferences. 
I  would  suggest  putting  in  the  words  "if  possible." 

Dr.  Liceaga.  I  believe  that  the  resolution  submitted  should  be 
voted  down,  because  no  Government  can  be  compelled  by  this  assem- 
bly to  appoint  given  Delegates.  The  Delegations  can  recommend  pri- 
vately to  their  respective  Governments  to  do  such  a  thing  as  an  advisa- 
ble one ;  but  that  resolution  should  be  voted  down  so  that  no  Govern- 
ment may  believe  itself  obliged  to  comply  with  it. 

The  President.     It  is  a  recommendation,  not  an  obligation. 

Dr.  Liceaga.  Even  if  it  were,  the  Governments  would  not  ac- 
cept it. 

The  President.     A  vote  will  be  taken  on  the  motion. 

Dr.  Castro.  It  seems  to  me  that  the  Delegate  from  Mexico  is 
right,  because  that  recommendation  would,  to  a  certain  extent,  be 
compulsory  to  the  Governments.  Of  course,  the  most  advisable  thing 
would  be  that  the  same  delegates  should  attend  the  next  Conference, 
thus  facilitating  the  work.  But  I  believe  that  we  should  confine  our- 
selves to  merely  suggesting  to  the  Governments  that  it  is  advisable  that 
they  send,  at  least,  a  Delegate  who  has  attended  a  previous  Conference, 
the  Governments  retaining,  however,  the  freedom  of  action  to  which 
they  are  entitled. 

The  President.  No  obligation  is  imposed ;  we  merely  recommend 
the  advisability  of  such  action;  that  is  what  my  resolution  says. 
The  Governments  can  send  whoever  they  choose ;  but  it  is  very  advisa- 
ble that  some  one  who  has  attended  a  previous  Conference  be  sent 
to  a  following  one,  thus  avoiding  explanations  and  loss  of  time,  these 
Conferences  being  devoted  to  actual  work,  and  not  to  academical 
speeches.  For  this  reason  we  must  cover  as  much  ground  as  possible 
within  the  shortest  possible  time. 

Dr.  Castro.     With  this  explanation,  I  approve  the  proposition. 

Dr.  Wyman.  I  am  inclined  to  think,  Mr.  President — I  would  like 
to  explain  my  vote — that  it  might  have  a  deterring  effect,  and  some 
one  Republic  might  misconstrue  the  resolution.  I  do  not  think  it 
makes  very  much  difference,  but  I  will  register  my  vote  as  opposed 
to  it. 

Dr.  Liceaga.  I  cast  my  vote  in  the  negative,  and  one  of  my  objec- 
tions is  the  same  as  that  of  the  majority  of  the  Delegates.  Are  we' 
going  to  ask  our  Governments  to  adopt  such  a  resolution?  I  think 
that  it  would  be  indelicate  on  our  part  to  do  so.  I  cast  my  vote  in  the 
negative. 

The  President.  I  do  not  believe  this  is  a  matter  of  delicacy,  but  a 
question  of  scientific  advisability.  If  we  were  to  have  Conferences 
in  which  all  the  Delegates  were  unfamiliar  with  their  proceedings,  we 
would  encounter  many  difficulties  and  lose  a  great  deal  of  time  without 
any  profit  whatever. 

Dr.  Vial.  Objection  might  be  overcome  by  adding  to  that  resolu- 
tion the  following  words:  "Or  that  the  said  Delegates  be  hygienists 
in  their  respective  countries,  or  competent  members  of  the  Health 
Bureaus." 


88  FOURTH   INTERNATIONAI-   SANITARY   CONFERENCE. 

The  President.  I  accept  that  suggestion,  and  if  the  Conference 
so  desires,  I  will  also  withdraw  my  motion,  because  I  do  not  want 
to  create  obstacles,  but,  on  the  contrary,  overcome  them. 

Dr.  Razetti.  I  think  that  the  amendment  proposed  by  Dr.  Vial  to 
the  motion  of  the  President  is  a  very  useful  one,  and,  therefore,  I 
adhere  to  it. 

Dr.  Liceaga.  I  am  going  to  take  the  liberty  to  read  the  fifth  reso- 
lution of  the  Conference  of  Mexico,  which  is  as  follows : 

V.  The  Second  International  Conference  of  the  American  States  further 
recommends,  in  the  interest  of  the  mutual  benefit  that  would  be  derived  there- 
from by  each  of  the  American  Republics,  and  that  they  may  more  readily  and 
effectively  co-operate  one  with  the  other  in  all  matters  appertaining  to  the 
subjects  mentioned  in  the  above  resolutions,  that  a  general  convention  of  repre- 
sentatives of  the  health  organizations  of  the  different  American  Republics  shall 
be  called  by  the  Governing  Board  of  the  National  Union  of  the  American 
Republics  to  meet  at  Washington,  D.  C,  within  one  year  from  the  date  of 
the  adoption  of  this  resolution  by  this  Conference ;  that  each  Government  repre- 
sented in  this  Conference  shall  designate  one  or  more  Delegates  to  attend 
such  Convention ;  that  authority  shall  be  conferred  by  each  Government  upon 
its  Delegates  to  enable  them  to  join  Delegates  from  the  other  Republics  in 
the  conclusion  of  such  sanitary  agreements  and  regulations  as  in  the  judgment 
of  said  Convention  may  be  in  the  best  interests  of  all  the  Republics  repre- 
sented therein ;  that  voting  in  said  Convention  shall  be  by  Republics ;  each 
Republic  represented  therein  to  have  one  vote;  that  said  Convention  shall  provide 
for  the  holding  of  subsequent  Sanitary  Conventions  at  such  regular  times, 
and  at  such  places  as  may  be  deemed  best  by  the  Convention ;  and  that  it  shall 
designate  a  permanent  Executive  Board  of  not  less  than  five  members,  who  shall 
hold  office  until  the  next  subsequent  Convention,  at  which  time  the  Board  shall 
be  appointed  with  a  Chairman  to  be  elected  by  ballot  by  the  Convention,  the 
said  Executive  Board  to  be  known  as  the  "International  Sanitary  Bureau,"  with 
permanent  headquarters  at  Washington,  D.  C. 

We  see,  therefore,  that  those  who  attend  these  Conventions  are  sani- 
tary agents,  and  it  thus  follows  that  they  are  persons  equipped  with  a 
knowledge  of  hygiene ;  consequently,  it  is  not  necessary  to  repeat 
that  provision  here,  this  being  the  basis  upon  which  we  exist. 

The  President.  Experience  shows  that  these  things  should  be 
repeated,  for  otherwise  they  would  not  be  done  as  they  should  be. 

Dr.  Liceaga.  Then,  let  us  say :  'Tt  is  advisable  that  the  Delegates 
be  health  officers  with  a  knowledge  of  the  regulations." 

The  President.  I  beg  Dr.  Vial  to  present,  in  writing,  his  amend- 
ment to  my  motion. 

Dr.  Vial  presented  his  amendment  in  the  following  manner:  "Or 
that  the  said  Delegates  he  hygienists  in  their  respective  countries." 

Dr.  Wyman.  I  suppose,  Mr.  President,  we  will  have  an  oppor- 
tunity to  vote  on  that  amendment — a  special  vote  on  the  amendment. 
There  is  a  resolution  before  the  house  and  then  this  resolution  to 
amend  the  first  resolution. 

The  President.  So  as  to  not  lose  too  much  time  I  have  accepted 
the  amendment  and  the  vote  will  be  upon  the  resolution  as  thus 
amended. 

Dr.  Wyman.  Then  I  am  more  strongly  opposed  than  ever  to  the 
resolution.  I  think  it  is  a  dangerous  thing  to  attempt  to  dictate  to  the 
Republics  what  men  they  should  send,  and  I  wish  to  say  further,  it  is 
not  always  necessary  that  we  should  have  medical  men  or  sanitarians, 
but  sometimes  a  diplomiatic  representative — it  was  thus  contemplated 


FOURTH   INTERNATIONAL  SANITARY  CONFERENCE.  89 

in  the  original  resolutions  passed  at  the  Conference  at  Mexico,  and 
a  diplomat  is  sometimes  quite  as  valuable  in  our  discussions  and  in 
considering  matters  which  come  before  us  as  perhaps  a  sanitarian 
would  be;  and,  at  any  rate,  I  fear  that  if  this  is  passed,  requesting  that 
a  member  of  the  board  of  health  be  sent — it  would  not  always  be  easy 
for  a  nation  to  send  a  member  of  the  board  of  health,  and  then  they 
would  think  we  would  not  receive  anyone  but  a  member  of  the  board 
of  health,  and  they  might  send  no  one.  If,  however,  you  have  ac- 
cepted the  amendment  then  the  vote  will  come  upon  the  resolution  as 
amended,  and  I  am  not  in  favor  of  it. 

The  President.  It  is  not  that  a  whole  delegation  should  be  that 
way,  but  in  case  they  have  two  delegates,  and  that  is  as  it  should  be, 
because  every  country  should  send  at  least  two,  and  in  that  case — 

Dr.  Wyman.     Yes ;  but  they  may  be  only  able  to  send  one. 

The  President.  But  in  case  they  send  only  one,  they  should  send 
someone  who  knows. 

Dr.  Wyman.  Well,  I  would  rather  have  a  stranger  than  to  have 
no  one  at  all. 

The  President.  I  believe  that  the  Governments  could  send  two 
Delegates,  one  of  them  a  physician  and  the  other  a  diplomat. 

Dr.  Wyman.  I  might  add,  Mr.  President,  we  can  effect  the  same 
thing  in  another  way.  The  President  of  the  Conference  could  pass 
the  word  around  that  it  is  desired  to  have  men  who  have  been  sent 
before,  if  possible ;  but  to  make  a  formal  declaration  in  this  Confer- 
ence, I  think,  might  endanger  the  attendance  at  the  Conferences. 

The  President.  I  suggest  a  different  thing,  to  wit :  That  recom- 
mendation be  made  to  the  Governments  in  whose  country  a  Confer- 
ence is  going  to  be  held  to  the  effect  that  the  invitations  therefor  state 
the  advisability  of  sending  Delegates  who  have  attended  previous  Con- 
ferences, or  at  least  one  of  the  Delegates  should  have  that  qualification. 

Dr.  Liceaga.  I  think  it  would  be  preferable  to  do  away  with  that 
proposition  entirely ;  because,  since  Dr.  Ulloa,  Dr.  Wyman,  and  other 
Delegates  here  present  are  members  of  the  International  Sanitary  Bu- 
reau of  Washington,  which  sends  the  invitations  through  its  Chair- 
man, Dr.  Wyman,  it  can  make  whatever  recommendations  may  be 
deemed  proper,  instead  of  embodying  such  recommendations  in  the 
resolution  from  this  assembly. 

The  President.  But  Dr.  Wyman,  who  is  to-day  the  Chairman  of 
that  Bureau,  may  cease  in  that  capacity.  Let  us  take  a  vote  on  my 
motion  with  the  amendment  suggested  by  Dr.  \'ial. 

(A  vote  was  taken  and  the  motion  carried,  as  amended.) 

Dr.  Liceaga.  I  request  that  my  vote  in  the  negative  be  recorded  in 
the  minutes. 

The  President.     The  next  resolution  is  as  follows : 

XL  To  request  of  the  Bureau  of  Information  of  IMontevideo  to  forward  a 
report  to  the  International  Sanitary  Bureau  at  Washington  of  its  transactions 
since  the  Third  International  Sanitary  Conference. 

Dr.  Liceaga.     I  second  the  motion. 

The  President.  There  is  some  doubt  as  to  the  functions  of  the 
Bureaus  of  Montevideo  and  Washington,  in  regard  to  which  some  peo- 
ple have  the  wrong  idea,  thinking  that  these  institutions  have  the  same 


90  FOURTH    INTERNATIONAL   SANITARY   CONFERENCE. 

duties,  and  not  understanding  that  the  Bureau  of  Washington  is 
the  one  of  last  resort.  The  Bureau  of  Montevideo,  to  which  the  report 
from  the  countries  under  its  jurisdiction  should  be  sent,  exists  for 
the  purposes  of  information.  Countries  lying  to  the  north  of  Ecuador 
report  to  the  Bureau  oi  Washington,  and  those  to  the  south  of  the 
same  Republic  to  that  of  Montevideo.  Therefore,  the  International 
'Central  Bureau  is  that  of  Washington,  which  Bureau  is  also  the  center 
of  information  for  the  countries  under  its  jurisdiction. 

(A  vote  was  taken  and  the  above  motion  was  carried.) 

The  following  resolutions  were  also  adopted: 

XII.  With  the  object  of  perfecting  the  knowledge  of  infectious  diseases  in 
the  Tropics  and  to  give  to  tropical  medicine  the  scientific  basis  now  held  by 
the  most  advanced  nations,  this  Conference  requests  of  the  Governments  of  the 
American  Republics  that  wherever  these  elements  of  progress  are  lacking  they 
encourage  every  project  tending  to  provide  special  information  on  parasitology 
and  on  pathological  anatomy. 

XIII.  To  request  also  of  the  Governments  of  the  American  Republics  that 
they  favor  the  establishment  in  seaports  and  important  cities  of  laboratories 
where  not  only  diagnoses  may  be  made  in  order  to  comply  with  the  require- 
ments contained  in  the  resolutions  of  our  sanitary  conventions,  but  where  also 
original  investigations  in  tropical  medicine  and  general  pathology  can  be  made 
along  lines  which  the  sanitary  authorities  deem  practicable. 

The  President.  If  the  Delegates  say  so,  we  will  now  proceed  with 
the  election  of  members  of  the  International  Sanitary  Bureau  of 
Washington. 

(On  suggestion  of  some  Delegates,  it  was  decided  to  take  up  this 
matter  at  the  afternoon  session.) 

The  President.  The  session  is  adjourned  until  2  o'clock  this 
afternoon,  when  we  will  dispose  of  the  pending  business  and  close  the 
Conference. 

(It  was  12.30  P.  M.) 


Afternoon  Session. 

The  Conference  was  called  to  order  by  the  President,  Dr.  Ulloa, 
•at  2.30  P.  M.,  all  the  Delegates  being  present,  with  the  exception  of 
Drs.  Amador  and  Porras. 

The  President.  The  Spanish  minutes  for  yesterday  morning's 
session  cannot  be  ready  because  there  has  not  been  sufficient  time  to 
prepare  them.  I  request  the  Delegates  to  authorize  the  Chair,  as  is 
customary,  to  approve  the  said  minutes  definitely.  As  soon  as  they  are 
ready  I  shall  see  that  they  are  sent  to  the  Delegations  present,  as  well 
as  copies  of  the  minutes  of  all  the  other  sessions ;  if  it  is  not  possible  to 
do  so  before  the  Delegates  leave,  those  copies  will  be  sent  them  by 
mail,  and  those  that  are  ready  will  be  given  to  them  before  leaving. 

(A  note  from  Dr.  Porras  was  read,  excusing  himself  on  account  of 
his  trip  to  the  United  States.  There  was  also  read  an  invitation  from 
the  Polo  Club  to  a  match  of  polo  in  honor  of  the  Delegates,  to  take 
place  at  nine  o'clock  the  following  morning  in  the  Savana.) 

The  President.  The  time  at  which  that  match  will  take  place  has 
not  yet  been  definitely  set,  and  the  delegates  will  be  informed  in  due 
time. 


FOURTH  INTERNATIONAL  SANITARY  CONFERENCE.  91 

The  Delegate  from  Colombia,  Dr.  Amador,  has  excused  himself 
from  attending  the  session  on  account  of  illness. 

A  subject  which  we  did  not  discuss  this  morning,  and  which  it  is 
in  order  to  discuss  now,  is  that  relating  to  the  11th  clause  of  the  pro- 
visional programme,  which  is  as  follows :  "Discussion  of  the  necessity 
that  all  European  nations  adopt  the  Convention  of  Washington,  as  well 
as  all  the  measures  recommended  by  previous  Conferences,  at  least, 
in  so  far  as  they  relate  to  the  colonies  in  America." 

The  reason  why  we  take  up  its  discussion  again  is  because  the 
Bureau  of  Washington  addressed  that  of  Paris  and  we  do  not  know 
as  yet  what  the  latter  has  answered  in  regard  to  the  subject. 

Dr.  Wyman.  We  sent  a  communication  to  the  Sanitary  Bureau 
at  Paris  and  received  a  reply  stating  that  they  would  be  very  glad  to 
co-operate  in  every  way  possible  with  the  International  Sanitary  Bu- 
reau of  American  Republics  at  Washington.  They  are  sending  out 
weekly  bulletins,  which  I  suppose  are  being  received  by  all  the  American 
Republics.  If  not,  it  will  be  my  pleasure  to  see  that  they  are  sent  to 
each  Republic.  Their  own  organization  has  been  barely  completed, 
but  at  the  last  meeting  last  summer  the  United  States  Government 
was  represented  by  Dr.  Geddings,  and  the  matter  of  the  co-operation 
between  the  two  international  sanitary  bureaus  was  brought  up  and 
agreed  to  in  a  general  way.  Nothing  specific  has  been  done  as  yet, 
but  it  is  expected  that  in  due  course  of  time  there  will  be.  In  regard 
to  the  adoption  by  the  colonial  interests  of  the  European  Governments 
of  our  regulations,  of  course,  that  must  be  a  matter  that  must  be 
brought  up  at  a  later  time  through  the  International  Saniary  Bureau 
if  it  is  practicable,  but  in  the  meantime  I  wish  to  say  that  at  the 
convention  of  the  colonial  interests  of  the  English  Government,  which, 
of  course,  are  very  large  in  the  West  Indies,  they  adopted  regulations 
which  are  practically  the  same  as  those  adopted  by  us.  So  that  there 
is  really,  so  far  as  the  English-speaking  colonial  authorities  are  con- 
cerned, very  little  difference,  if  any,  in  the  management  of  these  three 
epidemic  diseases,  very  little  difference  from  the  manner  in  which  we 
have  agreed  to  treat  them.  I  think  that  in  the  next  two  years,  before 
the  next  International  Sanitary  Convention  of  American  Republics  is 
held,  there  will  be  more  evidence  of  hearty  co-operation  between  the 
European  Governments  and  American  Republics  in  matters  of  sani- 
tation, brought  about  by  the  intervention  of  the  two  Bureaus,  one  at 
Washington  and  one  at  Paris. 

The  President.  Will  you  please  tell  me  when  you  saw  that  com- 
munication from  Paris? 

Dr.  Wyman.  Well,  it  was  received  during  the  summer,  signed  by 
the  proper  authority,  acknowledging  our  invitation  and  agreeing  to  it. 
It  was  only  one  page,  but  an  acknowledgment. 

The  President.  Did  you  say  those  publications  were  issued  weekly 
or  monthly? 

Dr.  Wyman.  Monthly,  And  they  are  published  only  in  the  French 
language. 

The  President.  In  accordance  with  the  programme,  it  is  now  in 
order  to  proceed  with  the  selection  of  the  place  where  the  Fifth  Inter- 
national Sanitary  Conference  shall  be  held.    The  Delegates  wishing  to 


92  FOURTH    INTERNATIONAL   SANITARY    CONFERENCE. 

take  the  floor  for  the  purpose  of  making  an  invitation  to  that  end,  in 
the  name  of  their  respective  countries,  may  do  so. 

Dr.  Vial.  Messrs.  Delegates:  It  is  extremely  gratifying  to  me  to 
offer  the  city  of  Santiago,  capital  of  the  Republic  of  Chile,  as  the 
place  for  the  next  International  Sanitary  Conference.  I  have  the 
honor  to  invite  the  Conference,  in  the  name  of  my  Government,  to 
that  city  for  such  an  important  purpose. 

The  President.  Is  there  any  other  Delegate  who  wishes  to  extend 
an  invitation  in  the  name  of  his  country? 

That  of  Chile  being  the  only  invitation,  I  move  that  that  made  by 
the  distinguished  representative  of  the  Chilean  Government,  in  its 
behalf,  be  accepted  unanimously.  (The  proposition  was  accepted  with 
great  applause.) 

The  President.  It  is  now  in  order  to  elect  the  President  for  the 
next  Conference,  and  I  take  the  liberty  to  propose  the  name  of  Dr. 
Maximo  Cienfugos,  ex-Secretary  of  State,  President  of  the  Supreme 
Board  of  Public  Hygiene  of  the  Republic  of  Chile,  and  Professor  of 
the  Faculty  of  Medicine  of  Santiago. 

(The  appointment,  as  proposed  by  the  President,  was  made  by  ac- 
clamation.)     (Great  applause.) 

The  President.  It  is  now  in  order  to  make  the  appointment  of 
the  members  of  the  International  Sanitary  Bureau  of  the  American 
Republics. 

Dr.  Liceaga.  I  beg  to  remind  the  Delegates  that  these  appoint- 
ments should  be  made  by  ballot. 

The  President.  These  appointments  have  always  been  made 
openly,  but  if  it  be  desired  that  they  be  made  by  ballot  we  shall  do  so. 

Dr.  Liceaga.  I  am  sure  that  we  all  cherish  the  same  feeling,  and 
that  we  ail  have  in  mind  one  single  name  for  Chairman  of  the  Interna- 
tional Sanitary  Bureau ;  but  I  thought  that  as  the  President  is  so  strict 
about  following  the  rules  we  should  not  now  deviate  from  them.  This, 
however,  does  not  alter  the  thought  that  we  all  have  in  mind. 

Dr.  Castro.  I  beg  to  submit  the  following  names  for  the  member- 
ship of  the  International  Sanitary  Bureau  of  Washington  during  the 
years  1910  and  1911:  Chairman,  Surgeon-General  Walter  Wyman; 
member  and  secretary.  Dr.  Juan  J.  Ulloa;  members,  Drs.  Ecluardo 
Liceaga,  Juan  Guiteras,  Pablo  Acosta,  Rhett  Goode,  and  Manuel  Ca- 
milo  Vial. 

The  President.  Let  us  first  make  the  election  of  the  Chairman. 
Is  there  anybody  who  wishes  to  propose  another  name  for  the  said 
position  aside   from  that  of   Dr.   Wyman? 

We  shall,  therefore,  proceed  with  the  election  by  ballot,  one  Delegate 
casting  one  vote  for  each  country,  and  to  this  end  I  reserve  the  right 
to  vote  for  Costa  Rica. 

(The  result  of  the  ballot  was  the  unanimous  election  of  Dr.  Walter 
Wyman  for  Chairman  of  the  International  Sanitary  Bureau.) 

Dr.  Wyman.  Mr.  President  and  gentlemen :  I  desire  to  thank  you 
for  this  continued  honor. 

The  election  of  the  Secretary  was  then  taken  up,  and  the  President 
designated  Dr.  Carlos  Duran,  of  the  Costa-Rican  Delegation,  to  cast  the 
vote  for  that  country. 


FOURTH  INTERNATIONAL  SANITARY  CONFERENCE.  93 

Dr.  Liceaga.  The  other  appointments  need  not  be  made  by  ballot, 
and  I  move  that  the  appointments  suggested  by  Dr.  Castro,  excluding 
my  name,  be  accepted. 

(The  appointments  were,  therefore,  made  as  follows:  Member  and 
Secretary,  Dr.  Juan  J.  Ulloa,  of  Costa  Rica ;  Members :  Drs.  Eduardo 
Liceaga,  of  Mexico ;  Juan  Guiteras,  of  Cuba ;  Pablo  Acosta,  of  Vene- 
zuela; Rhett  Goode,  of  the  United  States,  and  Manuel  Camilo  Vial, 
of  Chile.) 

The  President.  On  my  part,  I  thank  the  Conference  most  ex- 
pressively for  the  honor  that  it  has  conferred  upon  me. 

Dr.  Liceaga.     I  repeat  the  same,  in  so  far  as  I  am  concerned. 

Dr.  Acosta.  I  express  my  gratitude  for  the  honor  that  has  been 
extended  to  me. 

The  President,  Dr.  Liceaga  has  the  floor  for  the  purpose  of  sub- 
mitting a  motion. 

Dr.  Liceaga.  Messrs.  Delegates :  The  Mexican  Delegation,  through 
the  Fourth  International  Sanitary  Conference,  held  in  San  Jose,  de 
Costa  Rica,  from  December  25,  1909,  to  January  3,  1910,  begs  to  sub- 
mit the  following  motion : 

1st.  That  the  Convention  extend  its  most  expressive  thanks  to  the  people  and 
Government  of  Costa  Rica,  and  especially  to  the  President  of  the  Republic,  for 
the  ample  hospitality  and  excellent  comforts  that  they  have  accorded  to  the 
representatives  of  the  nations  here  assembled. 

With  respect  to  this  first  motion,  I  suggest  that  it  be  communicated 
to  the  President  of  the  Republic  through  a  Committee  composed  of 
three  members,  one  of  which  should  be  the  President  of  this  Con- 
ference. 

(A  vote  was  taken  on  this  motion,  which  was  unanimously  carried.) 

Dr.  Acosta.  I  move  that  that  committee  be  constituted  as  follows : 
Dr.  Juan  J.  Ulloa,  Surgeon-General  Dr.  Walter  Wyman,  and  Eduardo 
Liceaga. 

(A  vote  was  taken  on  this  motion,  which  was  unanimously  carried.) 

Dr.  Liceaga  (reading) : 

2d.  That,  for  the  same  reason,  the  thanks  of  the  Conference  be  extended  to 
the  Secretary  of  Foreign  Affairs  of  Costa  Rica  and  his  distinguished  consort. 

(This  motion  was  carried.) 

3d.  To  the  San  Jose  society  for  the  kind  attention  that  they  have  shown  us, 
and  most  particularly  to  the  ladies  of  San  Jose. 

(This  motion  was  carried.) 

4th.  To  the  Legation  of  Mexico,  near  the  Government  of  Costa  Rica,  for  the 
reception  that  it  gave  in  honor  of  the  l^elegates. 

(This  motion  was  carried.) 

5th.  To  the  Delegation  of  Costa  Rica,  which  so  cordially  has  accompanied 
the  Delegates,  acting  as  their  guide  in  visits  to  establishments  and  excursions; 
and  very  particularly  to  our  genial  President. 

Dr.  Wyman  then  spoke  in  English,  stating  that  all  the  Delegates 
iR'ere  ready  to  second  this  motion,  which  was  carried. 


94  FOURTH    INTERNATIONAL   SANITARY    CONFERENCE. 

6th.  To  the  Directors  of  the  Lyceum  of  Sati  Jose ;  of  the  San  Juan  de  Dios ;  of 
the  Chapui  Asylum,  and  of  the  penitentiary. 

(This  motion  was  carried.) 

To  the  International  Club ;  to  the  United  Fruit  Company ;  and  to  Tournon 
and  Company. 

(This  motion  was  carried.) 

As  I  suggested  previously,  the  Mexican  delegation  requests  also 
that  the  committee  of  three  members,  just  appointed,  make  a  special 
call  on  the  President  of  the  Republic  for  the  purpose  of  signifying  to 
him  the  sincere  recognition  of  the  Conference. 

The  President.  For  the  purpose  of  carrying  out  the  mission  which 
has  just  been  intrusted  to  me,  I  request  that  my  distinguished  fellow- 
members  in  that  committee  accompany  me  to-night  at  half -past  eight, 
if  that  time  be  suitable  to  them. 

I  request  the  Conference  to  authorize  the  Chair  to  finish  all  the 
business  that  may  be  left  pending  and  which  may  not  possibly  be 
disposed  of  by  the  Conference  before  the  closing  of  the  final  session. 

(This  proposition  was  approved.) 

The  President.  It  is  now  in  order,  in  accordance  with  the  pro- 
gramme, that  the  different  delegations,  through  one  of  their  members, 
deliver  brief  remarks  or  farewells  before  the  closing  of  the  Con- 
ference. 

The  Delegate  from  Chile  has  the  floor. 

Dr.  Vial.  Gentlemen,  if  hygiene  has  for  its  object  the  prevention  of 
diseases  it  is  unquestionable  that  this  Conference  has  a  transcendental 
importance. 

The  ancient  peoples  have  left  us  monuments  of  their  worship  to 
Hygeia,  the  Goddess  of  Health,  and  in  all  the  civilized  countries  they 
make  all  sorts  of  sacrifices  to  ameliorate  the  ravages  of  diseases,  and 
it  behooves  us  to  give  form  to  those  ideas. 

The  fruitful  results  of  these  Conferences  have  soon  manifested 
themselves,  and  the  sanitary  condition  of  the  Americas  has  been  con- 
siderably improved  by  them. 

Our  Government  thinks  so  and  has  endeavored  to  follow  those  same 
ideas. 

The  Government  of  Chile,  which  nowadays  spends  big  sums  of 
money  in  the  sanitation  of  its  cities,  gives  preferential  attention  to  its 
public  health  and  to  the  Maritime  sanitation  of  the  country,  and  always 
cares  for  the  welfare  of  its  citizens,  and  has  participated  in  the  four 
Sanitary  Conferences  that  the  American  Republics  initiated  in  Wash- 
ington in  1905. 

Therefore,  it  will  be  an  extreme  pleasure  for  my  Government  to 
assemble  the  next  Conference  in  its  capital,  which  will  afford  us  the 
opportunity  to  reciprocate,  even  though  partially,  the  exquisite  atten- 
tions that  our  Delegations  have  received  in  Washington,  Mexico,  and 
San  Jose  of  Costa  Rica. 

Consequently,  I  will  not  say  "Good-bye"  to  the  distinguished  Dele- 
gates from  the  sister  Republics  here  represented,  but  "Au  revoir." 

Before  closing  my  remarks,  I  wish  to  express  my  gratitude  to  the 
President  of  the  Republic  of  Costa  Rica,  his  Ministers  of  State,  the 


FOURTH   INTy-:RNATIONAL  SANITARY  CONFERENCE.  95 

distinguished  society  of  Costa  Rica,  and  the  delegation  of  the  same 
country,  whose  attention  have  deeply  obliged  us.      (Applause.) 

Dr.  Razetti.  The  Delegate  from  Colombia,  Dr.  Amador,  who  is 
ill,  has  requested  us  to  read  his  remarks,  which  are  as  follows : 

Mr.  President;  Messrs.  Delegates:  In  the  name  of  the  Government  of  Colom- 
'bia  I  beg  to  present  to  the  Government  of  this  beautiful  and  progressive  country 
the  expression  of  my  highest  gratitude  for  the  hospitable  and  regal  way  in  which 
this  country  has  received  us  and  entertained  us. 

Before  taking  leave  of  my  illustrious  colleagues,  who  have  not  omitted  any 
•effort  to  secure  for  the  American  Republics  the  greatest  benefits  to-day  offered 
by  hj'giene,  I  wish  to  pay  a  special  tribute  of  admiration  to  our  distinguished 
President  for  the  devotion  that  he  has  constantly  shown  to  everything  related 
to  the  success  of  this  Conference,  even  in  its  minutest  details. 

The  Government  of  this  country,  during  the  present  and  past  administrations, 
is  also  worthy  of  our  cordial  congratulations  for  the  maintenance  of  peace 
during  almost  half  a  century',  and  for  the  constant  development  of  its  national 
wealth,  which  it  invests  in  everything  that  tends  to  place  the  country  among 
the  most  civilized  nations.  This  Government  should  likewise  be  congratulated 
ior  the  enthusiasm  with  which  it  has  attended  to  its  hygiene. 

I,  who  have  had  the  privilege  of  residing  in  this  beautiful  country  even  though 
for  a  short  while,  can  appreciate  the  great  progress  that  it  has  achieved  during 
the  last  seventeen  years.  From  the  moment  one  arrives  at  Limon  one  sees 
to-day  straight  and  well  macadamized  streets,  beautiful  parks,  roomy  and  com- 
fortable houses,  and  a  good  sewerage  system. 

The  heart  of  every  Latin-American  should  feel  proud  of  the  good  nature  and 
peaceful  progress  of  this  industrious  country,  where  we  have  all  noticed  the 
extreme  refinement  of  the  gentlemen  and  the  beauty  and  elegance  of  the  ladies. 

My  esteemed  colleagues,  upon  leaving  you  my  only  regret  is  that  I  have  not  co- 
operated with  you  as  I  would  haA'c  liked,  thus  making  myself  worthy  of  the 
"honor  that  the  Government  of  Colombia  bestowed  upon  me  when  it  afforded 
me  an  opportunity  to  a  seat  among  you.  and  especially  among  those  whom  by 
their  constant  labor  we  may  consider  as  Titans  of  this  assembly. 

I  wish  you  all  sorts  of  happiness  in  the  future,  and  I  hope  that  when  you 
reach  your  homes  you  may  find  the  rest  that  you  so  much  deserve.     (Applause.) 

Dr.  Roberts.  Mr.  President,  Ladies  and  Gentlemen :  The  mission 
that  brought  us  to  this  prosperous  region  of  America  having  been 
accomplished,  and  on  the  eve  of  our  return  to  our  homes,  it  would  be 
ungrateful  if  we  were  to  leave  this  land — a  model  of  hospitality — 
without  expressing  our  appreciation. 

The  Fourth  International  Sanitary  Conference  of  American  Repub- 
lics has  ended  its  labors  ;  the  task  that  we  have  taken  upon  our  shoulders 
is  a  gigantic  one,  and,  like  all  enterprises  of  this  kind,  we  cannot  expect 
that  its  results  should  materialize  immediately,  but  we  have  advanced 
a  great  deal ;  our  task  is  based  on  the  welfare  of  our  fellow  beings,  it 
is  well  founded,  and,  therefore,  its  results,  although  slow  in  their  reali- 
zation, shall  attain  the  end  that  we  pursue. 

You  may  rest  assured  that  when  we  leave  Costa  Rica,  where  we 
have  received  so  many  attentions,  we  take  with  us  pleasant  impressions 
of  its  beauty  and  hospitality,  and  the  most  pleasant  recollection,  at  the 
same  time  wishing  its  people  the  greatest  prosperity  and  happiness. 
(Applause.) 

Dr.  Quinones.  Mr.  President,  Ladies  and  Gentlemen :  I  regret 
sincerely  that  I  have  to  leave  my  colleagues  and  this  country  that  has 
■entertained  us  so  splendidly  and  properly ;  but  the  moment  has  come, 
and  upon  expressing  my  deep  gratitude  for  the  attentions  that  the 
Government,  the  society,  and  the  public  of  Costa  Rica  have  extended 
to  us,  I  also  express  my  sincere  hope  that  this  country,  with  which 


96  FOURTH    INTERNATIONAL   SANITARY   CONFERENCE. 

the  Salvadoriaii  Government  and  people  maintain  so  cordial  relations^ 
shall  continue  its  onward  march  toward  progress. 

I  do  not  doubt  that  the  resolutions  adopted  by  this  Conference  will 
have  an  unquestionable  usefulness  throughout  the  nations  here  repre- 
sented, as  they  have  been  based  upon  the  latest  scientific  advances  that 
your  profound  knowledge  has  indicated,  and  to  which  I  have  not  been 
able  to  contribute  as  much  as  I  would  have  liked.  I  do  cherish  the  firm 
conviction  that  my  Government  will  know  how  to  interpret  them 
faithfully  and  will  give  them  the  approval  they  are  entitled  to. 

Most  sincerely  I  wish  you  a  happy  return  to  your  homes,  and  I 
hope  you  will  take  with  you  very  pleasant  impressions  of  the  most 
beautiful  country  of  Central  America.     (Applause.) 

Dr.  Wyman.  Mr.  President,  Ladies  and  Fellow  Delegates:  In 
speaking  words  of  farev;ell  on  behalf  of  the  Delegates  from  the  United 
States,  the  principal  feeling  which  we  have  at  this  time  is  regret, 
regret  that  this  pleasant  occasion,  that  this  fine  Convention,  that  this 
elegant  time  which  has  been  furnished  to  us  here,  is  about  to  come  to 
a  close  and  that  we  must  return  to  our  homes.  Of  course,  it  goes 
without  saying  that  we  are  desirous  of  reaching  our  homes,  but  we 
regret  ver}^  much  that  our  pleasant  time  here  has  come  to  an  end,  for 
it  will  always  remain  with  us  in  our  memories  as  one  of  the  most 
pleasant  we  have  ever  enjoyed.  With  regard  to  our  fellow  Delegates, 
we  feel  that  we  have  made  valuable,  profitable  acquaintances ;  we  feel 
that  we  have  come  closer  together;  we  feel  that  through  the  inter- 
mediary of  this  Convention  all  the  American  Republics  have  been 
brought  into  closer  relations  with  one  another,  for  through  sanitary 
work  it  is  certain  that  republics  can  be  brought  close  together.  And 
we  wish  particularly  to  speak  of  the  cordiality,  of  the  welcome,  the 
great  hospitality,  the  great  care  that  has  been  taken  for  our  comfort 
and  for  our  pleasure  by  the  representatives  of  Costa  Rica.  We  are 
delighted  to  have  been  in  Costa  Rica,  to  see  this  beautiful  country,  and 
to  see  this  beautiful  city,  and  we  shall  carry  back  with  us  the  warmest 
remembrance  of  the  kindness  which  has  been  extended  to  us.  We 
feel  better  acquainted  with  Costa  Rica  than  we  were  before  and  we 
have  greatly  appreciated  the  intercourse  which  we  have  had  with  the 
distinguished  men  of  your  country,  Mr.  President,  who  have  been  so 
cordial  in  their  reception  of  us,  and  we  have  been  greatly  charmed 
by  the  social  entertainments,  so  elegant  and  elaborate.  We  feel  com- 
plimented that  we  have  been  taken  into  your  homes  and  received  there, 
and  that  we  have  met  socially  the  people  of  this  city.  With  regard  to- 
the  Convention  itself,  I  feel  that  it  has  been  of  equal  importance  with 
the  others  which  have  been  held.  The  Fourth  International  Conven- 
tion I  feel  has  been  productive  of  great  good  and  has  justified  its  being 
called  into  existence ;  it  has  justified  all  the  sanitary  conventions ;  it  has 
justified  the  idea  of  International  Sanitary  Conventions;  and  I  feel  that 
the  serious  subjects  which  we  have  discussed  here  and  which  are  ex- 
pressed in  the  resolutions  which  have  been  passed,  will  be  productive 
of  great  good  to  all  the  countries  in  the  Western  Hemisphere. 

So  that  with  these  few  words,  the  American  Delegates  salute  yoit 
and  bid  you  farewell.     (Applause.) 

Dr.  Liceaga.  Mr.  President,  Messrs.  Delegates :  The  labor  ini- 
tiated by  the  previous  Conferences  is  beginning  to  show  its  good  re- 


FOURTH  INTERNATIONAL  SANITARY  CONFERENCE.  97 

suits.  This  is  proven  by  the  interesting  reports  read  by  the  Delegates 
from  the  nations  here  represented. 

The  onward  march  of  this  country  towards  the  betterment  of  sani- 
tary conditions  that  has  been  carried  out  already  in  different  cities 
and  ports;  the  projects  that  will  be  carried  out  to  provide  them  with 
water  and  sewer  systems ;  the  efforts  that  have  been  exerted  to  stamp 
out  yellow  fever  and  malaria  from  the  extensive  tropical  regions; 
the  measures  which  are  being  carried  out  everywhere  to  fight  tuber- 
culosis and  leprosy,  and  the  spread  of  vaccination  to  protect  our 
people  from  smallpox,  skow,  as  I  was  saying,  that  the  seeds  planted 
are  beginning  to  give  fruition. 

The  resolutions  adopted  by  this  Convention  will  strengthen  those 
recommended  by  the  previous  ones,  and  will  again  bring  to  the  atten- 
tion of  the  Governments  the  necessity  of  following  the  progress  of 
sanitary  science  for  the  service  of  public  health. 

The  Mexican  Delegation  hopes  that  the  next  Convention  will  be 
composed  of  representatives  from  a  greater  number  of  Republics,  and 
that  it  will  have  a  better  opportunity  for  the  solutions  of  new  prob- 
lems, and  that  it  will  continually  exert  the  best  efforts  for  the  purpose 
of  harmonizing  the  interests  of  public  health  with  those  of  commerce, 
navigation,  and  free  intercourse  of  men. 

Gentlemen,  the  Mexican  Delegation  is  pleased  to  express  its  senti- 
ment of  gratitude  for  the  cordial  welcome  that  it  has  received  from 
the  people  and  Government  of  Costa  Rica ;  for  the  splendid  hospitality 
that  has  been  extended  to  it;  for  the  attentions  that  it  has  received 
from  the  Delegates  of  other  nations;  and  for  the  delicate  courtesies 
that  have  been  shown  to  it  by  the  people  of  this  beautiful  and  privileged 
country,  by  its  illustrious,  modest,  and  worthy  President,  and  by  the 
learned  and  distinguished  society  of  San  Jose,  to  whom  we  would  not 
like  to  say  "good-bye"  but  "Au  revoir."     (Applause.) 

Dr.  Razetti.  The  Delegation  from  Venezuela  complies  with  the 
pleasant  duty  of  expressing  its  recognition  to  the  illustrious  Govern- 
ment and  learned  society  of  Costa  Rica  for  the  generous  hospitality 
that  it  has  received  in  this  interesting  country,  where,  due  to  the 
patriotic  spirit  of  its  people,  the  political  problem  of  modern  democracy 
is  solved;  peace  and  order  rule  in  the  midst  of  liberty  and  justice,  and 
love  for  work  prevails  as  the  only  factor  for  the  happiness  of  all. 
We  hope  that  the  conclusions  reached  by  this  Conference  will  be  a 
source  of  benefit  for  the  future  of  the  American  nations ;  and  that 
sanitary  science,  the  most  beautiful  product  of  modern  civilization, 
shall  contribute  to  strengthen  the  ties  of  international  confraternity 
in  the  Continent,  without  detriment  to  the  autonomy  and  the  inde- 
pendence of  the  nations  here  represented. 

The  Venezuelan  Delegation  expresses  its  sincere  wishes  for  the  wel- 
fare of  the  Costa  Rican  people,  for  the  personal  happiness  of  their 
worthy  President,  and  of  all  the  Delegates  here  present  and  their 
families,  very  particularly  for  that  of  the  most  worthy  Dr.  Ulloa,  who 
has  presided  over  our  sessions  with  so  much  interest,  and  who  is  one 
of  the  most  powerful  pillars  of  American  sanitary  science.  (Applause.) 

Dr.  Toledo.  Mr.  President,  Messrs.  Delegates :  The  time  has  come 
for  the  closing  of  the  Fourth  International  Sanitary  Conference  of  the 
American  Republics,  and  upon  addressing  you,  perhaps  for  the  last 


98  FOURTH    INTERKATIONAL   SANITARY    CONFERENCE. 

time,  I  comply  with  the  honorable  duty  of  thanking  you  in  the  name 
of  the  Government  and  people  of  Guatemala,  and  at  the  same  time  I 
present  to  you  their  congratulations  and  praises  for  the  great  work 
that  you  are  about  to  realize. 

The  improvement  of  public  health  in  the  different  nations  that  con- 
stitute the  American  Continent;  the  manner  of  preventing  the  intro- 
duction of  infectious  diseases  in  their  territories ;  the  adoption  of 
measures  tending  to  stop  their  propagation ;  the  measures  that  we  shall 
employ  to  prevent  their  becoming  epidemics ;  the  organization  and 
establishment  of  boards  of  public  health,  and  preparation  of  a  sani- 
tary code  which,  being  compulsory  for  all  the  nations  of  the  new 
world,  shall  guarantee  the  lives  and  property  of  our  peoples,  are  most 
important  points  connected  with  the  solution  of  the  difficult  problems 
intrusted  to  this  Conference. 

A  great  deal  has  been  done  in  this  respect  by  previous  Conferences 
and  the  sessions  about  to  close  to-day,  and,  although  there  is  yet  much 
to  be  done,  the  radiant  light  of  your  wise  principles  shall  be  an  able 
guide  that,  breaking  the -mysteries  of  Nature,  will  accomplish  for  us 
the  realization  of  that  idea. 

If  in  the  course  of  the  present  deliberations  my  limited  knowledge 
did  not  enable  me  to  co-operate  with  you  in  this  great  work  as  much 
as  I  would  have  liked,  you  may  at  least  rest  assured  that  when  I 
report  to  the  Government  of  Guatemala  on  the  resolutions  adopted 
by  this  learned  assembly,  they  will  all  be  endorsed  with  my  sincerest 
and  unconditional  approval,  and  you  may  likewise  feel  sure  that  that 
Government  will  accept  them  without  restrictions  or  hesitation,  and 
will  comply  with  them  just  as  it  has  complied  with  and  obeyed  the 
provisions  enacted  by  previous  Conferences. 

Within  a  few  days  many  of  you  shall  have  returned  to  your  homes,, 
enjoying  the  satisfaction  of  having  done  your  duty;  and,  if  upon 
abandoning  this  hospitable  land  you  leave  forever  engraved  in  our 
hearts  the  enlightening  splendor  of  your  science,  the  scintillating  light 
of  your  genius,  and  beneficial  fruition  of  your  efforts  and  aims  in  the 
interest  of  humanity,  in  exchange  you  shall  take  with  you  the  eternal 
gratitude  and  blessings  of  the  peoples  that  form  the  World  of  Co- 
lumbus.    (Applause.) 

Dr.  Vasqukz.  Mr.  President,  Ladies  and  Gentlemen :  I  wish  to 
express  my  gratitude  for  the  attentions  that  the  Delegate  from  Hon- 
duras has  received  from  the  Government  of  Costa  Rica  and  the  dis- 
tinguished society  of  San  Jose. 

Likewise,  I  wish  to  signify  to  the  Delegates  of  the  Conference  my 
appreciation  of  their  kindnesses,  and  upon  taking  leave  of  them,  I 
want  them  to  know  that  it  has  been  a  great  honor  for  me  to  be 
among  so  prominent  personages,  of  whom  I  shall  always  have  imper- 
ishable recollections. 

I  am  not  taking  leave  of  the  Delegates  from  Costa  Rica,  as  in  this, 
my  second  country  I  have  made  my  home ;  in  this  second  country  of 
mine,  which  I  love  as  dearly  as  my  own,  I  shall  live  with  them,  I 
shall  see  them  often,  and  often  I  shall  call  upon  them  for  advice. 
(Applause.) 

Dr.  Castro.  Ladies,  Mr.  President,  Messrs.  Delegates:  The  time 
has  come  to  end  the  labors  of  the  Fourth  International  American  Sani- 


FOURTH   INTERNATIONAL  SANITARY  CONFERENCE.  99 

tary  Conference,  and,  with  sincere  regret,  we  realize  now  that  the 
time  that  we  had  at  our  disposal,  to  discuss  with  due  care  all  the  sub- 
jects, was  short. 

Even  at  this  moment  we  can  foresee  that  the  results  of  this  Con- 
ference will  be  most  important,  and  that  not  only  will  they  be  of 
transcendental  importance  for  our  countries,  but  also  for  tropical 
pathology  and  for  humanity  in  general. 

I  congratulate  myself  for  the  work  accomplished  by  this  Conference, 
and  in  the  name  of  the  Government  of  the  Republic  of  Nicaragua  I 
offer  the  most  expressive  thanks  to  the  President  of  the  Republic 
of  Costa  Rica  and  to  his  illustrious  Government  for  the  splendid  hos- 
pitality extended  to  the  Delegates  of  the  nations  here  represented. 

To  the  learned  society  of  San  Jose,  which  so  splendidly  and  magnifi- 
cently entertained  the  distinguished  guests,  making  their  sojourn  in 
this  beautiful  city  most  pleasant. 

To  all  the  authorities  and  institutions  which,  by  their  courtesy  and 
attentions,  have  contributed  to  render  the  stay  of  the  foreign  represen- 
tatives most  interesting. 

To  our  genial  President,  Dr.  Juan  J.  Ulloa,  who,  with  unequalled 
tact  and  delicacy,  has  guided  our  deliberations.  Finally,  permit  me, 
gentlemen,  to  express  a  vote  of  gratitude  to  the  most  distinguished 
ladies  of  our  eminent  colleagues,  who  have  deigned  to  bring  a  ray 
of  their  grace  and  unique  beauty  into  the  midst  of  these  deliberations. 
(Applause.) 

The  President.  Ladies  and  gentlemen,  following  the  order  estab- 
lished in  previous  Conferences,  it  behooves  me  now  to  close  the 
sessions  of  the  Fourth  International  Sanitary  Conference  of  American 
Republics,  saying  the  words  which  will  adjourn  the  sessions  to  which 
you  have  given  so  much  importance  with  your  teaching  and  your 
experience  in  matters  connected  with  public  health. 

One  more  step  have  we  taken  in  the  path  that  will  lead  us  in  a  short 
time  to  the  point  that  we  pursue,  so  that  once  there  we  may  offer 
to  the  world  the  International  Sanitary  Code  of  this  Continent,  which 
will  serve  as  a  guaranty  for  the  safety  of  the  interests  of  the  countries 
that  we  represent  in  this  scientific  tournament,  where  no  literary 
beauties  are  seen,  but  which  results  in  resolutions  and  advices  whose 
object  is  the  welfare  and  happiness  of  those  who  follow  them. 

The  three  Conferences  held  during  the  last  six  years  have  already 
begun  to  produce  benefits  of  inestimable  value  in  the  nations  which 
have  legalized  the  resolutions  passed  by  their  official  representatives, 
as  is  abundantly  proven  by  the  victories  over  yellow  fever,  bubonic 
plague,  smallpox,  tuberculosis,  etc.  At  the  First  Sanitary  Conference 
of  the  Republics  of  America,  held  in  Washington  from  the  2d  to  the 
4th  of  December,  1902,  resolutions  were  passed  recommending  the 
Governments  therein  represented  to  adopt  the  measures  carried  out 
in  Havana  against  yellow  fever,  based  upon  the  discovery  of  Dr.  Finlay 
and  demonstrated  by  the  American  Committee,  composed  of  Dr. 
Reed,  Carroll,  Agramonte,  and  Lazear,  which  established  the  bite 
of  the  stegomya  mosquito  as  the  only  means  for  the  transmission  of 
the  disease. 

Messrs.   Delegates,   at  this   point,   it   is   fitting   that  we   should   all 
stand  up  to  pay  homage  to  the  memory  of  those  martyrs  of  science. 


100  FOURTH    INTERNATIONAL   SANITARY    CONFERENCE. 

Lazear  and  Carroll,  who  proved  with  their  lives  the  truth  of  the  doc- 
trine that  they  defended.  (All  the  Delegates  rose  in  respect  to  the 
memory  of  Drs.  Lazear  and  Carroll.) 

In  the  Second  Sanitary  Conference,  which  on  account  of  very  just 
reasons  could  not  be  held  in  Chile  and  had  to  assemble  in  Washington, 
we  were  able  to  conclude  within  the  brief  period  of  one  week  the  most 
important  discussion  that  resulted  in  the  Convention  of  Washington 
of  October  14,  1905,  in  regard  to  measures  against  cholera,  plague, 
and  yellow  fever,  which  was  approved  ad  referendum  by  eleven  Ameri- 
can Republics.  That  Convention  has  already  been  adopted  by  thirteen 
of  the  nations  of  this  Continent,  and  it  is  to  be  hoped  that  those 
which  have  not  accepted  it  yet  will  do  so  in  the  near  future,  to  avoid 
the  difficulties  which  might  come  to  them  when  the  countries  under  our 
Convention  shall  enforce  restrictive  measures  against  those  which  have 
not  adopted  it. 

In  the  Conference  held  in  Mexico  from  the  2d  to  7th  of  December, 
1907,  important  resolutions  were  adopted  against  smallpox,  tuber- 
culosis and  malaria. 

In  the  Fourth,  which  we  are  about  to  close,  we  have  agreed  in  recom- 
mending to  our  Governments  important  measures  against  plague  and 
malaria ;  we  have  interpreted  in  a  more  practical  manner  Article  IX 
of  the  Convention  of  Washington ;  we  have  prepared  resolutions  tend- 
ing to  the  betterment  of  cities,  and  more  especially  of  ports ;  we  have 
discussed  statistical  data  from  the  different  countries  represented  in 
regard  to  hygiene  and  sanitation ;  we  have  come  to  an  agreement  as  to 
the  preparation  of  uniform  sanitary  documents,  and  we  have  succeeded 
in  establishing  the  difference  between  International  Sanitary  Conven- 
tions and  Conferences,  which  will  greatly  facilitate  our  labors  in  the 
next  Conference. 

To  terminate,  gentlemen,  I  thank  you  for  the  kind  words  that  you 
have  addressed  me,  and  in  the  name  of  Costa  Rica  I  embrace  you 
and  I  wish  all  sorts  of  happiness  for  you,  for  your  families,  and  for 
the  countries  that  you  represent. 

I  hope  that  we  will  have  the  pleasure  of  meeting  again,  inside  of 
two  years,  when  we  shall  assemble  to  discuss  hygiene  and  sanitation 
around  the  sources  of  wisdom  of  Chile,  honor  and  glory  of  Latin- 
America.     Au  revoir,  my  colleagues.     (Applause.) 

Messrs.  Delegates,  all  standing,  we  close  the  sessions  of  the  Fourth 
International  Sanitary  Conference. 

(It  was  4  P.  M.) 


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APPENDIX. 


FOURTH  INTERNATIONAL  SANITARY  CONFERENCE  OF  THE 
AMERICAN  REPUBLICS. 


FESTIVITIES  AND   SOCIAL  FUNCTIONS  IN   HONOR  OF 
THE  DELEGATES. 

The  hospitalit}'^  and  courtesies  tendered  the  Delegates  by  the  Government 
of  Costa  Rica  and  the  residents  of  the  capital  were,  indeed,  of  the  most  remark- 
able character.  The  brief  account  given  below  will  only  give  a  small  idea  of 
their  splendor. 

At  the  very  outset  they  were  surprised  and  delighted  by  the  arrangements 
made  in  advance  for  their  comfort  and  welfare.  As  the  hotel  accommodations 
of  the  city  of  San  Jose  are  limited,  the  Government  set  aside  a  large  modern 
structure  perfectly  suited  to  the  purpose,  for  the  temporary  home  of  the  nation's 
guests,  for  such  the  delegates  became.  This  building,  near  the  main  plaza  and 
the  cathedral,  was  called  the  Hotel  del  los  Diputados,  and  this  became  the 
rendezvous  for  all  the  social  life  of  the  meeting;  in  it  everything  was  at  our 
disposal,  and  the  house  stafif  had  no  other  duty  than  to  help  us  enjoy  ourselves. 
No  expense  was  spared  by  the  Government  to  meet  this  end,  and  no  expense 
was  permitted  the  delegates  from  their  own  purses  if  it  came  within  the  legiti- 
mate requirements  of  the  work.  A  special  postal  and  telephone  service  was 
established,  carriages  were  at  our  disposal,  and  even  writing  paper  engraved 
with  the  name  of  the  Conference  was  freely  supplied.  Naturally,  a  vote  of 
thanks  from  the  delegates  was  unanimously  expressed  for  this  courteous  and 
liberal  hospitality. 

The  delegates,  once  settled  in  their  quarters,  were  invited  by  the  nation  or 
by  individuals  to  almost  innumerable  festivities.  In  the  beginning  there  was 
a  visit  to  the  office  of  the  Minister  of  Foreign  Affairs.  On  Christmas  Day, 
besides  the  formal  inaugural  session  presided  over  by  the  President  of  the 
Republic  in  person,  the  delegates  attended,  by  invitation  of  the  Government,  a 
gala  performance  given  by  a  Spanish  dramatic  company  in  the  National  Theater. 
Then  there  were  drives  to  the  several  hospitals  of  the  city,  to  the  schools, 
and  other  national  and  municipal  institutions ;  receptions  by  the  President  in 
his  official  residence;  dinners,  receptions  and  dances  by  the  Minister  of  Foreign 
Affairs,  the  United  States  Minister,  and  the  members  of  the  Mexican  Legation, 
at  many  of  which  society  of  both  sexes  attended  and  showed  that  charm  and 
graciousness  of  manner  which  is  so  fascinating  in  the  Latin  character.  So 
many  of  the  Costaricenses  have  been  educated  abroad  that  even  those  delegates 
who  spoke  little  Spanish  found  no  difficulty  in  enjoying  themselves  in  this 
polyglot  compan}',  while  those  who  danced  discovered  that  the  young  ladies 
were  perfectly  familiar  with  the  waltz  and  two-step  as  danced  in  the  ball  rooms 
of  New  York  and  Washington. 

The  three  occasions  which  will  always  be  remembered  by  those  who  had  the 
good  fortune  to  be  delegates  were  the  evening  reception  given  by  the  Minister 
of  Foreign  Relations  and  Sefiora  Guardia,  the  official  dinner  given  by  the 
President  of  the  Republic,  and  the  annual  New  Year's  Eve  ball  in  the  National 
Theater  given  by  society  as  a  whole,  this  year  in  honor  of  the  Sanitary  Con- 
ference. At  the  reception  a  glimpse  was  obtained  of  the  quieter  social  life 
of  the  capital,  where  young  and  old  alike  amused  themselves  by  conversation 
or  dancing,  as  happened  to  please.  The  presidential  dinner  was  more  formal, 
and  there  were  no  ladies ;  it  was  only  a  dinner  where  excellent  opportunity 
was  afforded  for  strangers  and  natives  to  become  acquainted  with  each  other, 
but  it  was  a  most  delightful  affair,  fully  equal  to  anything  that  could  be  served 
in  larger  and  more  cosmopolitan  capitals.  There  were  only  two  toasts,  one 
by  the  President  with  sincere  compliments  to  his  guests  and  wishes  for  suc- 
cessful results  from  the  Conference,  the  other  by  Doctor  Ulloa,  president  of 
the  Conference,  expressing  the  thanks  of  the  delegates  and  their  appreciation 
of  the  cordial  reception  extended  by  the  Republic. 


104  FOURTH    INTERNATIONAL   SANITARY   CONFERENCE. 

The  ball,  however,  was  the  climax  of  the  social  functions.  The  National 
Theater  was  decorated  in  gay  colors  for  the  occasion,  the  arist®cracy  of  Costa 
Rica  spared  no  pains  to  make  the  delegates  feel  at  home,  and  at  the  stroke  of 
midnight  the  health  for  the  new  year  was  drunk,  with  a  hearty  handshake  as 
if  among  old  friends.  Even  for  one  unacquainted  and  therefore  compelled  to 
stand  outside  of  the  gayety  and  look  on,  the  sight  was  truly  fascinating.  Not 
even  in  Paris  or  London  or  Washington  could  one  see  a  more  dazzling  array 
of  beautiful  women  more  beautifully  dressed;  the  boxes  were  full  of  spectators, 
the  floor  crowded  with  dancers;  the  music  was  such  as  only  a  trained  orchestra 
can  give.  Occasions  of  this  kind,  where  guests  and  hosts  alike  mingle  in  one 
common  and  spontaneous  feeling  of  enjoyment,  will  always  aid  incalculably 
to  the  strengthening  of  the  ties  of  Pan-Americanism. 


RESOLUTIONS  ADOPTED  BY  THE  FOURTH  INTERNA- 
TIONAL SANITARY  CONFERENCE  OF  THE  AMERI- 
CAN REPUBLICS. 

I.  With  respect  to  bilharziosis,  hydrophobia,  leprosy,  typhus  fever,  ankylosto- 
miasis, etc.,  this  Conference  suggests  that  recommendations  be  limited  to  request- 
ing the  various  governments  to  take  those  measures  of  protection  vi'hich  they 
believe  necessary. 

II.  (a)  To  recommend  especially  to  the  various  governments  that  they  em- 
ploy all  possible  means  at  their  disposal  to  secure  the  effective  sanitation  of 
seaports,  to  the  end  that  the  introduction  of  plague,  cholera,  and  yellow  fever 
may  be  prevented,  and  in  the  event  that  a  case  of  either  of  these  diseases 
reaches  a  port  that  it  be  promptly  isolated  and  measures  taken  to  prevent  its 
spread. 

(b)  To  recommend  special  ordinances  for  the  proper  construction  of  rat- 
proof  buildings,  especially  those  designed  for  the  storage  of  foodstuffs,  such 
as  markets,  granaries,  abattoirs,  stables,  etc. 

(c)  To  make  obligatory  the  use  of  galvanized  iron  garbage  cans  with  tight- 
fitting  covers  for  the  reception  of  refuse  from  houses,  and  to  arrange  for  the 
daily  disposal  of  such  refuse. 

(d)  That  properly  equipped  laboratories  be  provided  at  all  seaports  where 
the  periodical  examination  of  rats  may  be  made  so  that  plague  can  be  appre- 
hended before  its  appearance  in  human  beings. 

(e)  That  the  crusade  against  the  mosquitoes,  "Stegomya  calopus"  and  "Ano- 
pheles," be  carried  on  vigorously  along  lines  which  have  been  shown  to  bring- 
the  best  results. 

III.  (a)  That  careful  statistics  on  population,  morbidity,  and  mortality  be 
kept  at  every  port,  such  data  to  be  compiled  at  regular  intervals  of  not  more 
than  one  month,  and  also  annually. 

(b)  Every  port  should  be  provided  with  a  proper  system  of  sewerage,  an 
adequate  supply  of  pure  water,  and  paved  streets. 

(c)  That  all  habitations  be  constructed  with  a  view  to  furnishing  fresh  air 
and  sunlight  sufficient  to  maintain  the  health  and  vigor  of  the  inmates,  and 
that  the  character  of  the  construction  shall  conform  to  local  conditions. 

(d)  That  in  every  port  there  shall  be  a  sanitary  authority  clothed  with  ample 
power  to  vigorously  enforce  sanitary  ordinances. 

(e)  That  it  be  made  obligatory  in  schools  to  furnish  instruction  in  the  ele- 
mentary principles  of  hygiene  and  sanitation.  This  instruction  should  be  objec- 
tive, or  by  means  of  the  publication  of  simple  rules,  or  both. 

IV.  (a)  That  it  is  the  duty  of  owners  and  masters  of  vessels  to  rid  their 
vessels  of  rats  and  to  use  all  possible  means  to  keep  them  free  therefrom. 

(b)  That  this  should  be  accomplished  by  the  periodical  fumigation  of  holds 
of  vessels  with  sulphur  gas  at  periods  of  from  three  to  six  months  and  at 
times  when  advantage  may  be  taken  of  the  vessels  being  free  from  cargo  or 
laid  up  for  repairs;  and  at  all  other  times  vigilance  should  be  exercised  by 
the  masters  for  the  destruction  of  rats  by  such  other  means  as  they  deem- 
most  effective. 

V.  (a)  That  no  person  be  allowed  to  embark  who  is  suffering  from  a  quar- 
antinable  disease,  or  from  scarlet  fever,  measles,  diphtheria,  or  any  other  com- 
municable disease. 

(b)  For  permitting  the  embarkation  of  passengers  and  crew  who  have  been 
presumably  exposed  to  infection  where  the  above-mentioned  diseases  exist  there 
should  be  observed  at  the  port  of  embarkation  the  following  requirements : 

1.  Cholera,  five  days'  observation  or  surveillance ;  disinfection  of  baggage. 

2.  Smallpox  in  epidemic  form,  vaccination  or  other  evidence  of  immunity. 

3.  Tyhpus  fever  in  epidemic  form,  twelve  days'  detention  or  observation ; 
disinfection  of  baggage. 

4.  Plague,  seven  days'  detention  or  surveillance ;  disinfection  of  baggage. 

5.  Yellow  fever,  six  days'  detention  or  surveillance ;  or  immunity. 

(c)  Thorough  cleaning  of  all  portions  of  the  vessel  and  prompt  isolation  of 
all  cases  of  sickness  which  may  occur  on  board. 


106  FOURTH    INTERNATIONAL    SANITARY    CONFERENCE. 

VI.  The  Fourth  International  Conference  of  the  American  Republics  recom- 
mends that  Article  IX  of  the  convention  of  Washington  be  interpreted  as 
follows : 

Article  IX.  In  order  that  a  locality  be  considered  free  of  contagion,  it  will 
be  necessary  to  furnish  official  proof  to  the  satisfaction  of  the  interested  party. 

First.  That  there  have  been  no  deaths  nor  new  cases  of  plague  or  cholera 
for  five  days  after  the  isolation,  death,  or  discharge  of  the  last  case  of  plague 
or  cholera ;  in  the  case  of  yellow  fever  the  period  shall  be  eighteen  days,  but 
each  Government  reserves  the  right  to  prolong  this  period  against  those  coun- 
tries where  the  measures  for  the  isolation  of  cases,  the  destruction  of  mos- 
quitoes, and  the  disinfection  of  foci  are  not  observed. 

Second.  That  all  measures  of  disinfection  have  been  applied,  and  in  treating 
■of  plague  cases  that  there  have  been  carried  out  all  measures  for  the  destruc- 
tion of  rats,  and  in  the  case  of  yellow  fever  that  the  proper  measures  have 
been  taken  against  mosquitoes. 

VII.  To  recommend  that  the  Fifth  International  Sanitary  Convention  deter- 
mine  what  constitutes   immunity   from  yellow   fever. 

VIII.  To  recommend  to  the  Governments  here  represented  the  great  im- 
portance of  distributing,  in  all  possible  ways,  instructions  as  to  the  best  measures 
by  which  people  may  protect  themselves  against  malaria  and  tuberculosis, 
especially  by  the  publication  of  rules  to  control  these  diseases  and  by  making 
it  obligatory  on  the  part  of  employers  of  labor  to  supply  such  rules  and  to 
require  their  observance  by  their  employees. 

IX.  That  the  countries  here  represented  adopt  the  models  of  sanitary  docu- 
ments herewith  presented.     (See  page  110.) 

X.  To  recommend  to  the  Governments  represented  that  for  future  sanitary 
■conferences  there  be  nominated  delegates  who  have  assisted  at  previous  con- 
ferences ;  and  when  the  delegations  are  composed  of  more  than  one  member, 
that  one  of  them  shall  have  assisted  at  a  previous  conference,  or  that  in  any 
■case  the  delegates  shall  be  sanitary  authorities  in  their  respective  countries. 

XI.  To  request  of  the  Bureau  of  Information  of  Montevideo  to  forward  a 
report  to  the  International  Sanitary  Bureau  at  Washington  of  its  transactions 
■since  the  Third  International  Sanitary  Conference. 

XII.  With  the  object  of  perfecting  the  knowledge  of  infectious  diseases  in 
the  tropics  and  to  give  to  tropical  medicine  the  scientific  basis  now  held  by 
the  most  advanced  nations,  this  conference  requests  of  the  Governments  of  the 
American  Republics  that  wherever  these  elements  of  progress  are  lacking  they 
encourage  every  project  tending  to  provide  special  information  on  parasitology 
and  on  pathological  anatomy. 

XIII.  To  request  also  of  the  Governments  of  the  American  Republics  that 
they  favor  the  establishment  in  seaports  and  important  cities  of  laboratories 
where  not  only  diagnoses  may  be  made  in  order  to  comply  with  the  require- 
ments contained  in  the  resolutions  of  our  sanitary  conventions,  but  wher»  also 
original  investigations  in  tropical  medicine  and  general  pathology  can  be  made 
along  lines  which  the  sanitary  authorities  deem  practicable. 


REPORTS   SUBMITTED   BY   THE   DIFFERENT   COMMIT- 
TEES. 

REPORT    OF   THE    COMMITTEE    ON    CREDENTIALS. 
(This  report  appears  on  page  I'det  seq.) 

REPORT   OF   THE   EXECUTIVE   COMMITTEE. 
(This  report  appears  on  page  32.) 

REPORT   OF  THE   COMMITTEE   ON   SANITATION   OF   PORTS   AND 

CITIES. 

The  Committee  appointed  by  the  International  Sanitary  Convention  of  Ameri- 
can Republics,  at  San  Jose,  Costa  Rica,  December,  1909,  to  consider  the  resolu- 
tions adopted  by  the  Third  International  Conference  of  American  States  at 
Rio  Janeiro  in  August,  1906,  beg  leave  to  submit  the  following  report : 

The  aforesaid  resolutions  adopted  at  Rio  Janeiro  require  of  the  Sanitary 
Convention  a  study  of  the  following:  "The  adoption  of  measures  intended 
to  obtain  the  sanitation  of  the  cities  and  especially  of  the  ports,  as  well  as  to 
obtain  as  far  as  possible  a  better  knowledge  and  a  better  observance  of  hygienic 
and  sanitary  principles  and  practical  means  for  giving  effect"  to  the  recommen- 
dations made. 

The  committee  recommends  that  the  following  principles  be  transmitted  to 
the  Fourth  International  Conference  of  American  States  to  be  held  in  Buenos 
Ay  res  in  May,  1910. 

The  measures  to  be  adopted  are  as  follow* : 

1.  Vital  Statistics.  Every  port  should  have  statistics  as  to  population,  and 
an  accurate  record  of  morbidity  and  mortality  compiled  at  regular  intervals 
not  greater  than  one  month,  and  also  annually. 

2.  Sanitary  Conditions.  Each  port  should  be  provided  with  proper  sewerage, 
pure  and  ample  water  supply,  and  pavement  of  streets. 

3.  Dwellings.  All  habitations  should  be  so  constructed  as  to  provide  air  and 
sunlight  sufficient  to  maintain  the  health  and  vigor  of  the  inmates,  whatever 
the  character  of  the  structure  due  to  local  conditions. 

4.  Administration.  Each  port  should  be  provided  with  a  sanitary  authority 
with  full  power  to  enforce  sanitary  regulations. 

5.  Educational.  The  teaching  of  the  elementary  principles  of  hygiene  and 
sanitation  in  the  schools  should  be  obligatory.  This  instruction  should  be  either 
objective  or  by  the  publication  of  simple  rules,  or  by  both. 

We  have  further  to  recommend  that  the  foregoing  measures  be  adopted 
in  all  ports,  and  particularly  recommend  that  they  be  adopted  in  the  smaller 
ports. 

DRAFT    OF    RESOLUTIONS. 

Whereas,  Quarantine  regulations,  though  administered  with  the  greatest  care 
and  intelligence,  give  but  a  relative  degree  of  safety  in  the  prophylaxis  of 
communicable  diseases ;  and. 

Whereas,  In  view  of  these  limitations,  it  is  essential  that  we  strengthen  our 
second  line  of  defense  and  render  our  seaports  comparatively  impregnable 
to  the  invasion  of  epidemic  diseases; 

Resolved,  That  the  Convention,  through  its  members  individually  and  through 
every  avenue  open  to  its  influence,  use  all  proper  means  to  secure  efficient 
sanitation  of  seaports,  to  the  end  that  infections  such  as  bubonic  plague,  cholera 
and  yellow  fever  may  not  spread,  if  introduced ; 

Resolved,  That  specific  ordinances  be  recommended :     ' 

(a)  For  outlining  the  construction  of  rat-proof  buildings,  especially  those 
used  for  the  storage  of  food-stuffs,  such  as  granaries,  elevators,  markets,  abat- 
toirs, barns,  stables  and  warehouses. 


108  FOURTH    INTERNATIONAL   SANITARY   CONFERENCE. 

(b)  That  garbage  cans  of  galvanized  iron,  with  tightly  fitting  covers,  be 
provided  for  all  occupied  dwellings  and  arrangements  made  for  the  safe 
disposal  daily  of  garbage. 

Resolved,  That  the  crusade  against  the  mosquito  Stegomya  Calopus  contmue 
along  the  lines  shown  to  be  productive  of  the  best  results,  and  that  it  be 
carried  on  coincidently  with  the  campaign  against  Anopheles. 

Walter    Wyman,    Chairman. 

J.     E.     MONJARAS. 
R.    H.    VON    EZDORF. 

L.   Razetti. 

J.  M.  SoTO  Alfaro. 

REPORT  OF  THE  COMMITTEE  ON  MALARIA  AND  YELLOW  FEVER. 

Your  Committee  on  Malaria  and  Yellow  Fever  has  studied  the  propositions 
submitted  by  the  Mexican  Delegation  relative  to  the  interpretation  that  should 
be  given  to  Article  IX  of  the  Convention  of  Washington,  signed  on  October 
14,   1905. 

Your  Committee,  taking  into  consideration  that  the  Article  referred  to  has 
for  object  to  cause  the  least  possible  detriment  to  the  interests  of  the  country 
against  which  another  takes  measures  of  protection  from  yellow  fever,  believes 
that  the  said  Article,  in  saying  "in  the  case  of  yellow  fever  the  period  shall  be 
eighteen  days,  that  each  Government  may  reserve  the  right  to  extend  this 
period,  it  should  be  understood  that  right  is  to  be  made  use  of  against  coun- 
tries that  do  not  enforce  measures  of  isolation  of  patients  in  order  to  protect 
them  from  bites  of  infected  mosquitoes,  or  countries  which  do  not  take 
m.easures  for  the  destruction  of  mosquitoes;  it  should  be  understood  that  such 
rights  shall  not  be  availed  of  in  the  case  of  the  United  States,  Mexico,  Cuba, 
Costa  Rica  and  such  other  nations  as  are  actively  and  successfully  working 
to  secure  the  eradication  of  yellow  fever  from  their  respective  territories; 
therefore,  this  committee  submits  to  the  consideration  of  the  Convention  the 
following  resolution : 

"Article  IX  of  the  Convention  of  Washington  should  be  interpreted  as 
follows : 

"Article  IX.  In  order  that  a  locality  be  considered  free  of  contagion,  it  will 
be  necessary  to  furnish  official  proof  to  the  satisfaction  of  the  interested  party." 

Your  Committee  on  Malaria  and  Yellow  Fever  has  likewise  studied  the 
proposition  of  the  delegate  from  Cuba  (see  page  113)  to  the  effect  of  defining 
when  an  individual  may  be  considered  as  immune  against  yellow  fever. 

Your  Committee,  considering  that  the  proposed  question  is  already  defined 
by  science,  since  only  persons  who  have  already  suffered  from  yellow  fever 
are  considered  immune,  the  proposition  of  the  delegate  from  Cuba  may  be  held 
as  scientifically  solved,  but  as  the  practical  difficulty  lies  in  the  manner  of  ascer- 
taining when  such  persons  were  attacked  by  yellow  fever,  your  committee 
begs  to  submit  the  following  resolution : 

The  practical  solution  of  the  propositions  submitted  by  the  delegate  from 
Cuba  are  referred  to  the  consideration  of  the  Fifth  International  Sanitary 
Conference  of  the  American  Republics. 

Your  Committee  on  Yellow  Fever  and  Malaria  has  studied  the  propositions 
submitted  by  Doctor  Elias  Rojas,  delegate  from  Costa  Rica  (see  page  — ), 
and,  considering  that  they  tend  to  impress  upon  the  minds  of  the  people  the 
doctrine  of  the  transmission  of  malaria  and  of  the  proper  means  of  protection 
therefrom,  your  committee  proposes  the  following  resolution : 

To  recommend  to  the  Governments  represented  in  this  Conference  that  the 
propositions  submitted  by  Doctor  Rojas  be  seriously  taken  into  consideration. 

Your  Committee  on  Yellow  Fever  and  Malaria  has  studied  the  propositions 
submitted  by  Doctor  Carlos  Duran,  Delegate  from  Costa  Rica,  relating  to 
recommendations  that  should  be  made  to  respective  Governments  upon  the 
advisability  of  enacting  laws  enforcing  the  measures  adopted  by  the  previous 
sonventions  for  the  permanent  eradication  of  malaria  in  tropical  countries.  As 
the   propositions    of   Doctor    Duran    tend   to    secure   the   practicability   of   the- 


FOURTH  INTERNATIONAL  SANITARY  CONFERENCE,  109 

measures    advocated    by    the   previous    Conventions,    your    committee    begs    to 
submit  the  following  resolutions: 

The  propositions  submitted  by  Doctor  Duran  should  be  added  to  the 
resolutions  adopted  by  previous  Conventions. 

Eduardo    Liceaga,    Chairman. 

Hugo  Roberts. 

Carlos  Duran. 

Elias  Rojas. 

J.  W.  Amesse. 

Fernando  Vasquez. 

dissenting  vote  of  dr.  hugo  roberts. 

Messrs.  Delegates :  I  have  voted  against  the  new  interpretation  of  Article  IX 
of  the  Convention  of  Washington  because  according  to  the  present  construc- 
tion the  Governments  are  authorized  to  extend  the  period,  without  giving 
official  explanations  of  any  sort,  while  according  to  the  proposed  interpretation 
in  order  to  extend  that  period  it  would  be  necessary  to  make  an  accusation 
of  non-compliance,  which  might  give  rise  to  an  exchange  of  diplomatic  notes, 
perhaps  to  no  avail,  and  such  a  course  would  always  be  disagreeable.  Also, 
because  experience  in  Cuba  has  proven  that,  despite  all  possible  efforts  and 
all  necessary  measures,  cases  occur  sometimes  within  periods  much  longer 
than  eighteen  days,  which  shows  that  the  epidemic  was  not  eradicated  in  that 
period. 

REPORT  OF  THE  COMMITTEE  ON  MEASURES  FOR  PROTECTION 

OF  PASSENGERS. 

The  undersigned,  members  of  the  committee  on  measures  for  the  protection 
of  passengers  of  the  Fourth  International  Sanitary  Conference  of  the  American 
Republics,  have  established  the  propositions  presented  by  the  Delegation  of  the 
United  States  of  America  on  measures  for  the  protection  of  passengers  em- 
barking in  infected  ports,  and,  taking  into  consideration  the  remarks  of 
Doctor  Von  Ezdorf,  we  are  of  the  opinion  that  the  following  resolutions  be 
recommended : 

First.  That  no  person  be  allowed  to  embark  who  is  suffering  from  a  quar- 
antinable  disease,  or  from  scarlet  fever,  measles,  diphtheria,  or  any  other  com- 
municable disease. 

Second.  For  permitting  the  embarkment  of  passengers  and  crew  who  have 
been  presumably  exposed  to  infection  where  the  above-mentioned  diseases  exist 
there  should  be  observed  at  the  port  of  embarkment  the  following  requirements: 

(a)  Cholera,  five  days'  observation  for  surveillance ;  disinfection  of  baggage. 

(b)  Smallpox  in  epidemic  form,  vaccination  or  other  evidence  of  immunity. 

(c)  Typhus  fever  in  epidemic  form,  twelve  days'  detention  or  observation; 
disinfection  of  baggage. 

(d)  Plague,  seven  days'  detention  or  surveillance;  disinfection  of  baggage. 

(e)  Yellow  fever,  six  days'  detention  or  surveillance,  or  immunity. 

By  complying  with  these  measures  and  thorough  cleaning  of  all  portions 
of  the  vessels,  and  prompt  isolation  of  all  cases  of  sickness  which  may  occur 
on  board,  the  stringency  of  quarantine  measures  at  the  port  of  arrival  will  be 
greatly  diminished. 

Your  committee  opines  that  the  observation  of  the  above-mentioned  measures 
be  recommended,  and  that  every  Government  be  requested  to  report  to  the 
next  Conference  the  manner  in  which  said  measures  have  been  carried  out. 

Carlos    Duran,    Chairman. 

R.  H.  von  Ezdorf. 

Jose  Maria  Soto  A. 

Pablo  Acosta  Ortiz. 

Nazario  Toledo. 

Alfonso  Quinones. 


110  FOURTH    INTERNATIONAL   SANITARY    CONFERENCE. 

REPORT  OF  THE  COMMITTEE  ON  SANITARY  DOCUMENTS. 

Your  committee  has  studied  the  models  for  Bills  of  Health  that  were  sub- 
mitted to  it,  and,  considering  that  the  one  accepted  by  the  committee  contains 
the  greatest  number  of  data  needed  by  the  sanitary  authorities  at  the  port  of 
arrival,  it  recommends  its  adoption. 

This  document  is  composed  of  two  models,  to  wit:  one  is  the  original  Bill  of 
Health  issued  at  the  port  of  clearance,  and  the  other,  supplementary  to  the 
former,  to  be  issued  in  the  port  where  the  vessel  stops  in  transit. 

In  view  of  the  consideration  above  set  forth,  your  committee  proposes  the 
following  resolution : 

That  the  countries  here  represented  adopt  the  models  of  sanitary  documents 
herewith  presented. 

Hugo   Roberts,   Chairman. 
Eduardo   Liceaga. 
J.  W.  Amesse. 
Martin  Amador. 
Luis  Razetti. 

(Name  of  country.) 

Port  of 

No 

BILL  OF  HEALTH. 

I, 

(the  person  authorized  to  issue  the  bill),  at  the  Port  of 

do  hereby  state  that  the  vessel  hereinafter  named  clears  from  this  Port  under 
the   following   circumstances : 

Name  of  vessel, ;   Nationality, ;  Rig, 

;   Master, ;   Tonnage,  gross, ; 

net, ;   Iron   or  wood, ;    Number  of  compartments   for  cargo, ; 

For  steerage  passengers, ;   For  crew,    ;    Name  of  Medical   Officer, 


Number   of  officers ;    Number   of  members   of   officers'   families, ; 

Number  of  crew,  including  petty  officers, ;   Number  of  passengers,  cabin, 

;   Number  of  passengers,   steerage, ;    Number  of  persons  on 

board,  all  told, 

Port   of   departure,    

Where   last   from 

Number  of  cases  of  sickness,  and  character  of  same,  during  last  voyage, 

Number   of  cases   of   sickness,   and   character   of   same,   while   vessel   was   in 

this  port,    

Vessel  engaged  in trade,  and  plies  between and 

Sanitary  condition  of  vessel,   

Nature,  sanitary  history,  and  condition  of  cargo, 

Source  and  wholesomeness  of  water  supply 

Source  and  wholesomeness  of  food  supply 

Sanitary  history  and  health  of  officers  and  crew, 

Sanitary  history  and  health  of  passengers,  cabin 

Sanitary  history  and  health  of  passengers,  steerage,   

Sanitary  history  and  condition  of  their  effects,    

Prevailing  diseases  at  port  and  vicinity, ;  malaria ; 

deaths  past  calendar  month. 

Location  of  vessel  while  discharging  and  loading — open  bay,  or  wharf? 

Duration  of  stay  in  this  port 


FOURTH  INTERNATIONAL  SANITARY  CONFERENCE. 


Ill 


Number  or  Cases  and  Deaths  From  the  Following-Named  Diseases  During 

THE  Past  Two  Weeks  : 

remarks. 

Any  conditions  affecting 
,  the    public    health    existing 

in  the  port  of  departure 
or  vicinity  to  be  here 
stated. 

When  there  are  no  cases 
3r    deaths,    entry    to     that 


Diseases. 


No. 
Cases. 


No. 
Deaths. 


effect  must  be  made. 


Yellow   Fever    

Asiatic    Cholera    

Cholera  Nostras,  or  Cholerine. 

Smallpox 

Typhus  Fever   

Plague 

Leprosy  


I  certify  that  the  vessel  has  complied  with  the  quarantine  rules  and  regula- 
tions made  under  the  law  of ,  and  that  the  vessel  leaves 

this   Port  bound for (name   of    Port 

and  country) ,  via 

Given  under  my  hand  and  seal  this day  of ,  191.  . 

(seal)  (Signature  of  consular  officer.) 

(seal)  


Vessel 


(Name  of  Country.) 
SUPPLEMENTAL  RILL   OF  HEALTH. 
Port  of 


U.  S.  A. 


Bound  from   to 

Sanitary  condition  of  port  

State  infection  diseases  prevailing  at  port  and  in  surrounding  country 

;  malaria — deaths  during  past  calendar  month 

Location  of  vessel  while  discharging  and  loading — open  bay  or  wharf 

Number   of  cases   and   deaths   from    the   follozuing-named   diseases   during   the 
past  two  weeks: 


Diseases. 


(Any    condition    affecting 
the   public   health    existing 
No  No       in   the  port,   to  be    stated 

Cases.*    Deaths. *here.) 


Yellow   Fever    

Asiatic    Cholera    

Cholera  Nostras,  or  Cholerine. 

Smallpox 

Typhus  Fever   

Plague  

Leprosy  


*If  no  cases  and  no  deaths,  the  facts  to  be  stated  in  these  columns. 


112  FOURTH    INTERNATIONAL   SANITARY   CONFERENCE. 


Time  vessel  was  in  port   

Number  and  sanitary  condition  of  passengers  and  crew  landed  at  this  port: 

Cabin  passengers,  No ;  sanitary  condition  and  history: 

Steerage  passengers,  No ;   sanitary  condition  and  history : 

Crew,  No ;   sanitary  condition   and  history: 

(If  disembarked  on  account  of  sickness,  state  disease.) 

Number  and  sanitary  condition  of  passengers  and  crew  taken  on  at  this  port, 
and  sanitary  condition  of  effects: 

Cabin,  No ;  sanitary  condition  and  history ; 

Steerage,  No ;  sanitary  condition  and  history : 

Crew,   No ;   sanitary  condition  and  history : 

Sanitary   condition   of   effects : 

Total  passengers  aboard ;  total  crew  abroad 


Sanitary  history  of  vessel  since  leaving  last  port: 
Form.     (Cancel  Form  A,  B,  or  C,  as  the  case  requires.) 


no  quarantinable  disease  has  ap- 
>peared  aboard  since  leaving 


A. — To  the  best  of  my  knowledge  and^ 
belief — 

(Form  A  will  be  used  at  interme- 
diate ports  where  the  vessel  does 
not  enter  and  clear.) 
B. — I  have  satisfied  myself  that — 

(Form  B  will  be  used  at  interme- 
diate ports  where  the  vessel  en- 
ters and  clears.) 

C. — Since   leaving the   following-named   quarantinable 

disease  has  appeared  on  board ,  and  I  certify  that 

the  necessary  sanitary  measures  have  been  taken. 

I  certify  also  that  with  reference  to  the  passengers,  effects,  and  cargo  taken 
on  at  this  port,  the  vessel  has  complied  with  the  rules  and  regulations  made 

under  the  law  of 

GIVEN  under  my  hand  and  seal  this day  of ,  191. .. . 

(Signature  of  Consular  OfRcer.) 

(Seal.) 


PROPOSITIONS  SUBMITTED  BY  DIFFERENT  DELE- 
GATES. 

PROPOSITION  SUBMITTED  BY  DOCTOR  ELIAS  ROJAS,  DELEGATE 

FROM  COSTA  RICA. 

Whereas,  The  Fourth  International  Sanitary  Conference  has  for  object,  be- 
sides several  others,  to  recommend  such  measures  as  are  adequate  to  fight  the 
ravages  of  malaria,  which  disease  is,  undoubtedly,  the  endemic  of  tropical 
countries ; 

Whereas,  The  Third  International  Sanitary  Conference  recommended  to  the 
Governments  there  represented  the  publication  of  a  pamphlet  wherein  shall  be 
compiled  in  a  brief,  simple  and  practical  form  and  in  such  manner  that  the 
people  at  large  will  readily  understand  it  all  useful  information  concerning 
malaria,  and  to  freely  distribute  said  pamphlet ; 

Whereas,  Though  it  be  true  that  among  the  countries  represented,  are  some 
as  the  United  States  of  America,  the  Mexican  United  States,  Cuba,  and  Panama, 
which  have  already  undertaken,  with  brilliant  success,  the  campaign  against 
malaria,  there  are  others  where  this  campaign  has  been  undertaken  but  in  arv 
imperfect  manner;  and,  in  order  to  take  advantage  of  the  experience  of  countries 
which  have  preceded  us  in  this  work,  the  undersigned  begs  to  move : 

First.  That  the  Fourth  International  Sanitary  Conference  of  the  American 
Republics,  an  International  Commission,  to  prepare  a  pamphlet  wherein  shall 
be  compiled  in  a  brief,  simple  and  practical  form,  and  in  such  manner  that  the 
people  at  large  will  readily  understand  it,  all  information  and  recommendations 
of  principles  concerning  malaria;  and  of  posters,  concise  form,  regarding  the 
manner  of  preventing  malaria,  to  be  posted  in  conspicuous  places,  in  schools, 
churches,  railroad  stations,  and  other  public  places  in  regions  where  malaria 
prevails.  This  Commission  shall  likewise  prepare  models  of  postal  cards  and 
pictures  of  all  kinds  for  popularizing  all  information  concerning  the  prevention 
of  malarial  infection. 

Second.  In  the  next  International  Conference  each  Government  interested 
shall  signify  the  number  of  copies  of  the  pamphlet,  posters,  postal  cards,  etc., 
which  it  will  take. 

PROPOSITION   PRESENTED   BY   DOCTOR   CARLOS   DURAN,   DELE- 
GATE FROM  COSTA  RICA. 

I  propose,  as  a  measure  of  extreme  advisability  and  of  incalculable  benefits 
for  the  people  of  America,  that  the  Governments  of  the  countries  represented 
at  this  Conferenc  be  invited  to  enforce  such  laws  or  provisions  as  they  deem 
advisable  in  all  places  the  climate  of  which  is  favorable  to  the  development  of 
malaria,  such  laws  or  provisions  to  embody  the  following  essential  require- 
ments :  First.  That  it  be  made  the  duty  of  proprietors  of  farms  or  agricultural 
or  industrial  establishments  to  protect  their  employees,  laborers  or  peons  against 
mosquito  bites,  furnishing  their  houses  with  the  necessary  means  therefor, 
such  as  providing  the  doors  and  windows  with  wire  screens ;  frequent  fumiga- 
tion, and  drainage  of  swamps,  etc.,  in  the  neighborhood  of  such  houses.  Second. 
That  said  owners  be  compelled  to  furnish  their  employees  and  laborers  with 
the  amount  of  quinine  necessary  for  prophylaxis  dOses;  and,  Third.  That  one 
or  more  official  inspectors  be  appointed  to  enforce  the  compliance  with  the 
above  provisions  and  to  apply  the  penalties  prescribed  for  violations  of  the 
lav/. 

PROPOSITION  SUBMITTED  BY  DOCTOR  HUGO  ROBERTS,  DELE- 
GATE FROM  CUBA. 

The  Convention  of  Washington  of  1905  makes  provision  for  the  treatment 
to  which  vessels  infected  or  suspected  of  yellow  fever  should  be  subjected,  and 
prescribes  that,  if  possible,  immune  persons  be  employed  for  discharging  the 
cargo ;  it  also  makes  reference  to  the  rules  that  should  be  observed  with  regard 
to  non-immune  personnel.  Now,  then,  it  is  generally  admitted  that  individuals 
who  have  lived  a  long  time  in  an  endemic  focus  of  yellow  fever  are  immune 


114  FOURTH   INTERNATIONAL   SANITARY   CONFERENCE. 

to  the  disease,  even  if  there  be  no  indications  that  they  have  previously  suffered 
from  it ;  there  are  also  some  people  who  consider  an  individual  immune  for 
the  simple  fact  that  he  was  born  in  a  place  favorable  to  the  development  of 
yellow  fever   (hot  lands). 

Therefore,  in  order  that  there  may  be  a  uniform  opinion  in  regard  to  what 
constitutes  immunity  from  yellow  fever,  the  undersigned  delegates  move : 

First.  That  the  next  International  Sanitary  Conference  determine  what  should 
be  the  conditions  in  an  individual  to  be  considered  as  immune  from  yellow 
fever. 

Second.  That  a  delegate  from  each  nation  report  upon  the  limits  of  endemic 
foci  that  exists  or  have  existed  of  yellow  fever  in  their  respective  countries, 
specifying,  in  the  latter  case,  the  dates  on  which  said  foci  ceased  to  exist. 

PROPOSITION  SUBMITTED  BY  DOCTOR  WALTER  WYMAN,  CHAIR- 
MAN OF  THE  UNITED  STATES  DELEGATION. 

Whereas,  Plague  is  a  disease  which  is  carried  from  one  country  to  another 
by  the  rat;   and, 

Whereas,  The  rat  commonly  infests  vessels  engaged  in  commerce;  and. 

Whereas,  Rats  in  vessels  may  be  destroyed  by  measures  that  are  not  difficult 
of  enforcement  and  that  involve  but  moderate  expense ;  and, 

Whereas,  The  further  spread  of  this  disease  among  the  countries  of  the 
Western  Hemisphere  is  a  matter  of  grave  concern  and  should  be  prevented 
for  the  sake  of  preserving  human  life  and  for  the  preserving  of  commercial 
prosperity  in  the  ports  of  the  American  Republics ;  therefore,  be  it 

Resolved,  That  it  is  the  duty  of  owners  and  masters  of  vessels  to  rid  their 
vessels  of  this  pest  and  to  keep  them  free  therefrom;  and  be  it  further 

Resolved,  That  this  should  be  accomplished  by  the  periodical  fumigations 
of  holds  of  vessels  with  sulphur  gas  at  periods  of  from  three  to  six  months, 
and  at  times  when  advantage  m.ay  be  taken  of  the  vessels  being  free  from  cargo 
or  laid  up  for  repairs ;  and  at  all  other  times  vigilance  should  be  exercised  by 
the  masters  for  the  destruction  of  rats  by  such  means  as  they  may  deem  most 
effective. 

PROPOSITION    SUBMITTED    BY    DOCTOR    JOSfi    MARIA    SOTO    A., 
DELEGATE  FROM  COSTA  RICA. 

The  undersigned  begs  to  state  that  in  the  report  presented  the  Delegation 
of  Costa  Rica  mention  is  made  of  two  serious  diseases,  of  which  no  cases 
have  been  reported  in  the  country  as  yet.  These  diseases  are  rabies  and 
hybaticysts  of  the  liver.  And,  whereas,  in  previous  Conferences  these  diseases 
were  not  discussed,  and  as  they  may  easily  be  transmitted  through  the  intro- 
duction of  foreign  dogs,  I  beg  to  submit  to  the  consideration  of  my  illustrious 
colleagues  the  following  resolution : 

That  measures  relating  to  the  importation  of  foreign  dogs  should  be  adopted, 
either  by  submitting  them  to  a  strict  quarantine  or  requiring  the  production 
of  authentic  certificates  of  vaccination  or  by  absolutely  prohibiting  the  introduc- 
tion of  foreign  dogs  in  countries  where  said  diseases  have  not  yet  appeared. 

PROPOSITION    SUBMITTED    BY   DOCTOR   VICENTE   CASTRO   CER- 
VANTES, DELEGATE  FROM  NICARAGUA. 

I  move  that  bilharziosis  be  added  to  the  list  of  diseases  against  which  are 
designed  the  preventive  measures  provided  for  by  this  Convention  intending  to 
prevent  or  limit  their  propagation. 

Therefore,  microscopic  diagnosis  of  the  intestinal  and  renal  secretions  of 
every  individual  suffering  from  dysentery  or  from  hematurias,  especially  if  he 
comes  from  a  place  where  undoubtedly  these  dangerous  parasites  live  in 
company  with  men. 

The  protection  of  indemne  individuals  shall  be  made  manii  militari  if  neces- 
sary, by  virtue  and  enforcement  of  regulations  which  may  be  adopted  by  a 
commission  of  physicians  who  are  familiar  with  this  problem  or  are  inter- 
ested therein. 


LETTERS  CONCERNING  THE  FOURTH  INTERNATIONAL 
SANITARY  CONFERENCE  OF  THE  AMERICAN  RE- 
PUBLICS. 

Imperial  Hotel^  San  Jose,  Costa  Rica,  December  20,  1909. 

Doctor  Juan  J.  Ulloa, 

President  of  the  International  Sanitary  Conference. 

Sir :  I  have  the  honor  to  inform  you  that  I  received  yesterday  from  the  De- 
partment of  Foreign   Relations  of  Colombia   a   cablegram  accrediting  me   as  a 
Delegate    from   that   country   to    the    International    Sanitary    Conference    which 
will  be  held  in  this  city  on  the  25th  instant. 
I  have  the  honor  to  be,  Mr.  President, 

Very  respectfully  yours, 

Martin  Amador. 


Republic  of  Costa  Rica,  Department  of  Foreign  Relations, 

San  Jose,  December  20,   1909. 

Mr.  President :  I  have  the  honor  to  inform  you  that,  in  the  order  indicated  in 

the   respective   list,  the  m.embers   of  the   Faculty  of   Medicine   and   Surgery  of 

Costa  Rica  will  be  invited  to  the  inaugural  session  of  the  Fourth  International 

Sanitary  Conference  of  the  American  Republics. 

I  have  the  pleasure  to  renew  the  assurances  of  my  distinguished  consideration 

Pedro  Iglesias. 
Doctor  Juan  J.  Ulloa, 

President  of  the  Fourth  International  Sanitary  Conference  of  the  American 
Republics. 


Republic  of  Costa  Rica,  Department  of  Foreign  Relations, 

San  Jose,  December  22,  1909. 

Mr.  President :  For  your  information,  I  have  the  honor  to  transcribe  below 
a  note,  dated  the  ISth  instant,  addressed  to  me  by  the  Minister  for  Foreign 
Relations  of  Guatemala.     It  is  as  follows : 

"Excellency :  I  have  the  honor  to  confirm  the  cablegram  which,  in  answer  to 
that  sent  me  by  Your  Excellency,  I  addressed  Your  Excellency  yesterday  in- 
forming the  illustrious  Government  of  the  sister  nation  that  Doctor  Nazario 
Toledo  had  been  appointed  Delegate  from  Guatemala  to  the  Sanitary  Conven- 
tion that  will  be  held  in  that  capital.  Upon  informing  Your  Excellency  that  by 
a  previous  mail  the  Full  Powers  of  Doctor  Toledo  were  sent  to  him,  I  avail 
rnyself  of  this  opportunity  to  offer  Your  Excellency  the  assurance  of  my 
highest  and  distinguished  consideration. — G.  Aguirre." 

I  have  the  pleasure  to  renew  the  testimony  of  my  distinguished  consideration. 

R.  Fernandez  Guardia. 
Doctor  Juan  J.  Ulloa, 

President  of  the  Fourth  International  Sanitary  Conference  of  the  American 
Republics. 


Republic  of  Costa  Rica,  Department  of  Foreign  Relations, 

San  Jose,  December  24,   1909. 
Mr.   President :  For  your  information,  I  have  the  honor  to  transcribe  below 
a  note,  dated  the  7th   of  August,  last,  addressed  to  me  by  the   Secretary  for 
Foreign  Relations  of  the  Republic  of  Honduras.     It  is  as  follows: 


116  FOURTH    INTERNATIONAL   SANITARY   CONFERENCE. 

"Mr.  Minister :  Complying  with  my  oflfer  of  the  second  instant,  I  have  the 
pleasure  to  inform  Your  Excellency  that  by  a  supreme  resolution  of  even 
■date,  Doctor  Fernando  Vasquez  was  appointed  Official  Representative  of  my 
Government  before  the  Fourth  International  Sanitary  Conference  that  will  be 
"held  in  that  city  from  December  25th  of  the  present  year  to  January  2,  1910. 
The  respective  credential  has  already  been  issued  to  said  Doctor.  In  commu- 
nicating the  above  to  the  Government  of  Your  Excellency  I  have  the  honor  to 
renew  the  testimony  of  my  high  esteem  and  distinguished  consideration. — 
Jose  Ma.  Ochoa  V." 

It  is  my  pleasure  to  renew  the  assurances  of  my  most  distinguished  con- 
sideration. 

Doctor  Juan  J.  Ulloa, 

President  of  the  Fourth  International  Sanitary  Conference  of  the  American 
Republics. 


Republic  of  Costa  Rica,  Department  of  Foreign  Relations, 

San  Jost,  December  28,  1909. 

Mr.  President :  I  have  the  honor  to  inform  you  that  this  Department,  com- 
plying with  the  request  that  you  made,  issued  in  due  time  twenty-six  invitations 
addressed  to  the  President  of  the  Faculty  of  Medicine  of  Costa  Rica  for  such 
physicians  that  might  have  desired  to  be  present  at  the  inauguration  of  the 
Fourth  International  Conference  of  the  American  Republics.  Likewise,  it  sent 
box  seats  to  the  Delegates  and  their  families. 

As,  after  sending  the  seats  referred  to,  no  other  suggestion  or  request  was 
received  in  regard  to  the  subject,  this  Department  believes  that  it  has  duly 
fulfilled  its  duty  in  the  matter. 

I  take  advantage  of  this  opportunity  to  renew  the  testimony  of  my  highest 
and  most  distinguished  consideration. 

Pedro  Iglesias, 
Assistant  Secretary. 
Doctor  Juan  J.  Ulloa, 

President  of  the  Fourth  International  Sanitary  Conference  of  the  American 
Republics. 


Republic  of  Costa  Rica,  Department  of  Foreign  Relations, 

San  Jose,  December  29,  1909. 

Mr.  President :  I  have  the  honor  to  enclose  herewith  copy  of  a  note  of  yester- 
date,  received  to-day  in  this  Department  from  the  Legation  of  Nicaragua,  relative 
to  the  appointment  of  Dr.  Vicente  Castro  Cervantes  as  Delegate  from  Nicaragua 
to  the  Fourth  International  Sanitary  Conference  of  the  American  Republics. 

I  avail  myself  of  this  opportunity  to  renew  the  assurances  of  my  highest 
consideration. 

R.  Fernandez  Guardia. 
Doctor  Juan  J.  Ulloa, 

President  of  the  Fourth  International  Sanitary  Conference  of  the  American 
Republics. 


Legation  of  Nicaragua, 

San  Jose,  Costa  Rica,  December  28,  1909. 

Excellency:  I  have  the  honor  to  inform  Your  Excellency  that,  under  date  of 
yesterday,  the  Government  of  Nicaragua  has  appointed  as  its  Delegate  to  the 
Fourth   International   Sanitary   Conference  Doctor  Vicente   Castro,   whose   ap- 


FOURTH  INTERNATIONAL  SANITARY  CONFERENCE.  117 

pointment  I  beg  Your  Excellency  to  communicate  to  the  President  of  the  said 
Conference. 

I  beg  Your  Excellency  to   accept  the   renewed   assurances  of  my  most   dis- 
tinguisned  consideration. 

Alceo  Hazera, 
His  Excellency,  Senor  Ricardo  Fernandez  Guardia, 
Minister  for  Foreign  Relations. 


Republic  of  Costa  Rica,  Department  of  Foreign  Relations, 

San  Jose,  December  30,  1909. 

Mr.  President:  For  your  information,  I  have  the  honor  to  transcribe  herein  a 
•cablegram  received  yesterday  in  this  Department  from  the  Minister  for  Foreign 
Affairs  of  Paraguay.     It  is  as  follovv^s : 

"This  Government  regrets  its  inability  to  take  part  in  the  Sanitary  Confer- 
•ence,  reserving  the  right  to  adhere  to  the  conclusions  thereof. — Respectfully, 
M.  Jongra." 

I  renew  the  testimony  of  my  distinguished  consideration  and  esteem. 

R.  Fernandez  Guardia, 
Doctor  Juan  J.  Ulloa, 

President  of  the  Fourth  International  Sanitary  Conference  of  the  American 
Republics. 


REPORT   OF   DR.    MANUEL   CAMILO    VIAL,    DELEGATE 

FROM  CHILE. 

Gentlemen,  upon  presenting  myself  among  you,  I  have  the  extreme  gratifica- 
tion of  reporting  to  you  that  under  date  of  July  23d,  of  the  present  year,  the 
International  Convention  subscribed  in  Washington,  in  1905,  was  promulgated 
as  a  \s.^N  of  the  Republic.     (Annex  1.) 

On  May  30,  1908,  the  Government  of  the  Republic  decreed  the  creation  of 
the  International  Chilean  Information  Commission  of  the  American  Republics, 
with  headquarters  at  Santiago,  and  composed  of  Drs.  Ricardo  Davila  Boza, 
Director  of  the  Institute  of  Hygiene ;  Lucio  Cordova,  Secretary  of  the  Superior 
Board  of  Public  Hygiene,  and  Pedro  Lautaro  Ferrer,  Sanitary  Inspector  of 
the  Republic.     (Annex  2.) 

INFECTIOUS   DISEASES    IN    CHILE. 

Bubonic  Plague. — During  the  years  1908  and  1909  we  had  a  few  cases  of 
bubonic  plague  in  Arica,  Yquique,  Antofagasta,  Taltal,  Tocopilla,  and  Valparaiso, 
and  an  epidemic  in   Mejillones. 

In  Arica  there  were,  in  1908,  43  cases  of  plague  with  eleven  deaths.  In  the 
present  year,  up  to  December  1st,  only  32  cases  were  reported.  The  Sanitary 
Station  of  Arica  isolates  and  treats  the  patients,  disinfects  the  rooms,  isolates 
or  watches  persons  that  have  been  in  contact  with  plague  patients,  co-operated 
by  the  administrative  authorities,  who  carry  out  constant  domiciliary  visits, 
clean  the  streets  and  houses,  and  close  rooms  for  a  definite  period  of  time. 
(Annex  3,  Reports  of  the  Sanitary  Station  of  Arica.) 

In  Yquique  there  were,  in  1908,  203  cases  of  bubonic  plague  with  17  deaths. 
Out  of  the  133  cases  that  were  cured,  64  were  treated  in  their  own  homes  and 
69  in  the  lazaretto. 

During  the  present  year  only  75  cases  have  been   reported. 

The  Municipal  Chemical  Laboratory  is  entrusted  with  the  disinfection  of 
houses  and  is  provided  with  good  chemical  and  bacteriological  instruments. 
(Annex  4,  Statistical  tables.) 

In  Antofagasta  there  were,  in  1908,  171  cases  of  plague  with  59  deaths. 

Due  to  the  ever-increasing  importance  of  this  port,  the  Supreme  Government 
is  now  carrying  on  sanitation  works  that  will  soon  provide  that  port  with  a 
sewer  system,  greater  water  supply,  and  a  special  system  for  the  distribution 
of  sea  water  for  cleaning  sewers,  for  the  fire  pumps  and  for  other  public  and 
private  services. 

In  Taltal  and  Tocopilla  the  cases  of  plague  have  been  comparatively  few,  and 
the  Bureau  of  Public  Works  has  already  studied  the  sewer  and  waterworks 
which  will  soon  be  carried  out  in  the  former. 

In  Valparaiso,  the  first  commercial  code  of  Chile,  there  have  also  been  some 
small  epidemics  which  were  destroyed  in  time,  thanks  to  the  energetic  measures 
enforced  by  the  administrative  authorities,  together  with  its  Municipal  Health 
Department. 

From  December,  1907,  to  December,  1908,  there  were  59  cases  with  27  deaths. 
In  the  present  year  no  case  has  been  reported. 

The  reconstruction  of  the  borough  of  Almendral,  which  was  destroyed  by  the 
earthquake  of  1906,  is  carried  on  with  great  activity,  and,  when  completed,  will 
provide  that  borough  with  wide  avenues,  many  gardens,  and  a  complete 
Municipal  Department  of  Public  Health,  with  an  adequate  building  of  its  own. 
(Annex  4,  Bis.,  Plans,  etc.) 

In  Mejillones,  a  port  recently  opened  to  international  commerce  and  con- 
nected with  Antofagasta  by  rail,  there  has  been  an  epidemic  of  bubonic  plague 
which  lasted  from  the  latter  part  of  1908  until  September  of  the  present  year. 

The  Central  Government  was  placed  in  the  necessity  of  organizing  an 
extraordinary  service,  sending  the  Sanitary  Inspector,  Dr.  Ferrer,  with  full 
power  to  organize  it  and  direct  it,  and' vVith  a  complete  personnel  of  nurses 
and  disinfectors.  '" 

The  total  number  of  cases  treated  in  the  houses  and  lazarettos  was  177, 
with    61    deaths,    or   34.36   per    cent.    The    prophylactic    method    employed   by 


120  FOURTH    INTERNATIOXAL    SANITARY    CONFERENCE. 

Dr.  Ferrer  consisted  of  the  application  of  the  Yersin  serum,  and,  three  days 
after,  of  the  Haffkine  vaccine. 

The  sanitary  personnel,  as  well  as  the  families  of  the  patients,  were  immunized 
in  that  manner,  or  an  approximate  total  of  three  hundred  families,  which 
method  gave  most  brilliant  results  without  any  serious  accidents. 

The  anti-plague  serum  of  Yersin  and  the  Haffkine  vaccine  cannot  yet  be 
prepared  in  the  Institute  of  Hygiene  of  Santiago,  and  it  is,  therefore,  pe- 
riodically ordered  from  the  Pasteur  Institute  of  Paris,  and  distributed  gratui- 
tously wherever  it  is  necessary  for  use  in  the  lazarettos,  and  on  special  occasions 
for  private  use. 

Yellow  fever  and  cholera  are  unknown  in  Chile,  and  no  cases  have  ever 
arrived  from  abroad  in  our  ports. 

Some  cases  of  trachoma  and  beri-beri  have  arrived  in  steamers  coming  from 
Kongkong,  but  the  Sanitary  Station  of  Arica  had  enforced  special  measures 
and  the  Government  enacted  additional  measures  by  the  Supreme  Decree  No. 
2909.     (See  Report  of  the  Sanitary  Station  of  Arica.) 

The  Supreme  Government,  with  the  advice  of  the  Superior  Council  of  Public 
Hygiene,  has  now  under  consideration  a  set  of  regulations  to  prevent  the  intro- 
duction by  Asiatic  immigrants  of  this  new  calamity. 

Malaria  prevails  in  the  towns  and  the  valleys  of  the  Province  of  Tacna,  but 
in  isolated  cases,  and  the  Sanitary  Station  of  Arica  has  made  and  is  making 
special  studies  of  that  disease,  for  the  purpose  of  submitting  to  the  consideration 
of  the  Government  such  hygienic  measures  as  will  improve  the  sanitary 
condition  of  that  Province,  whose  benign  climate  and  uniformity  of  average 
temperature  will  enable  it  to  become  one  of  the  healthiest  in  the  country. 

Smallpox  has  been  the  infecto-contagious  disease  that  has  done  the  greatest 
damage  in  our  country,  both  in  its  endemic  and  epidemic  forms.  Sometimes 
it  decreases  until  it  almost  disappears,  only  to  reappear  sooner  or  later,  causing 
new  and  terrible  ravages.  In  the  years  1906  and  1907  the  mortality  decreased 
in  such  a  way  that  we  cherished  hopes  that  it  would  disappear  entirely,  leaving 
only  a  few  isolated  cases  in  the  Province  of  Concepcion  and  the  Auracanian 
frontier.  In  January  of  the  present  year  the  first  cases  that  appeared  in 
Santiago  were  recorded  in  the  northern  and  northeastern  boroughs  which  had 
been  invaded  by  the  disease  on  former  occasions.  The  epidemic  spread  so 
rapidly  that  the  authorities  were  compelled  to  adopt  extraordinary  measures. 
On  May  4th  the  Government  promulgated  the  sanitary  police  law  for  the 
City  of  Santiago,  and  on  the  29th  of  the  same  month  made  it  applicable  to  the 
whole  country.     (Annex  5.) 

To  fight  the  epidemic,  a  special  Board  of  Health  was  organized  under  the 
presidency  of  the  Intendent  of  the  Province,  and  of  which  were  also  members  the 
President  of  the  Superior  Council  of  Hygiene,  the  President  of  the  Central 
Vaccination  Board,  the  First  Mayor  of  the  Municipality,  and  the  Chief  of  the 
Division  of  Serotherapy  of  the  Institute  of  Hygiene.  This  Board  of  Health 
ordered  the  increase  of  the  extraordinary  corps  of  vaccinators,  and  decided 
to  accept  the  offer  of  the  medical  students  for  the  purpose  of  carrying  on  more 
rapidly  the  vaccination  of  the  inhabitants  of  the  city. 

The  output  of  vaccine  virus  manufactured  by  the  Division  of  Serotherapy  of 
the  Institute  of  Hygiene  was  increased  and  the  cleaning  of  the  city  was  under- 
taken. The  amount  of  vaccine  delivered  to  the  Central  Board  of  Health  from 
April  23d  to  July  23d  of  the  present  year  as  follows :  121,226  plates,  each 
for  the  vaccination  of  five  persons;  445  tubes,  each  for  the  vaccination  of  from 
25  to  50  persons,  that  is  to  say,  the  necessary  vaccine  for  617,265  vaccinations. 

The  number  of  vaccinations  effected  during  the  same  period  was  of  28,601 
original  vaccinations,  and  161,505  revaccinations,  or  a  total  of  190,106. 

The  cases  of  smallpox  treated  in  the  lazaretto  of  San  Jose  from  January  1st 
to  November  30th  of  the  present  year  was  3,800,  with  2,071  deaths,  or  54.50 
per  cent ;  the  cases  treated  in  houses  have  been  incalculable. 

The  disease  prevailed  among  the  untidy  and  ignorant  masses  of  the  people, 
who  could  not  be  made  to  understand  that  vaccine  was  a  preventive  of  the 
disease ;  it  also  prevailed  in  comparatively  remote  boroughs.  The  Government 
gave  the  Municipality  all  sorts  of  fagjlities  and  liberal  amounts  of  money  for 
the  cleaning  of  the  city.  The  same  facilities  were  given  to  the  Board  of 
Beneficence  for  the  isolation  of  the  sick.  The  Medical  Division  of  the  Police 
Department  was  entrusted  with  the  execution  of  the  orders  of  the  Board  of 


FOURTH  INTERNATIONAL  SANITARY  CONFERENCE.  121 

Health  and  with  the  enforcement  of  the  Sanitary  Police  Law.  In  the  beginning 
of  December  the  epidemic  was  already  under  control,  only  a  few  cases  remain- 
ing in  the  lazaretto. 

The  intercourse  between  Santiago  and  the  Provinces  facilitated  the  spread 
of  the  disease  to  some  of  them,  although  no  extraordinary  number  of  cases 
was  reported  in  any. 

We  have  not  as  yet  in  our  country  a  law  making  vaccination  compulsory,, 
and  for  that  reason  smallpox  still  exists. 

This  being  known  as  the  only  prophylactic  means  against  the  disease,  the 
hygienists  have  for  many  years  directed  their  efforts  to  secure  from  our 
legislature  a  law  making  vaccination  compulsory,  and  only  recently  the  Supreme 
Government  included  that  project  among  the  subjects  that  will  be  taken  up 
by  Congress  in  the  present  extraordinary  session. 

Diphtheria,  typhoid  fever  and  scarlet  fever  also  appear  from  time  to  time- 
in  small  epidemic  foci. 

The  bacteriological  diagnosis  of  diphtheria  and  typhoid  fever  is  made  free 
of  charge  to  the  public  by  the  Institute  of  Hygiene  of  Santiago.  In  1906  there 
were  in  Santiago  82  cases,  and  during  the  present  year  70  have  been  reported 
so  far.  The  anti-diphtheric  serum  is  manufactured  by  the  Division  of  Sero- 
therapy, which  in  1908  produced  2,051  tubes  of  20  cubic  centimeters.  This 
serum  is  given  to  the  public  free  of  charge  upon  presentation  of  an  order 
from  any  physician. 

Typhoid  fever  exists  principally  in  the  beginning  of  fall,  attacking  persons 
arriving  in  Santiago  from  the  country  places  where  they  go  to  spend  the 
summer,  and  where  the  sources  of  water  supply  are  in  poor  condition.  During 
1908  ihere  were  reported  in  the  capital  120  cases,  and  in  the  present  year  92,  up- 
to   the   present    date. 

In  1908  there  were  88  cases  of  scarlet  fever,  and  56  during  the  present  year. 

TUBERCULOSIS    IN    CHILE. 

By  decree  of  April  15th,  the  charter  of  the  "Santiago  League  Against 
Tuberculosis"  was  approved,  and  in  1903  the  "Ladies'  Association  Against 
Tuberculosis"  was  legally  constituted. 

The  League  Against  Tuberculosis  founded  and  organized  a  maritime  sana- 
torium which  was  inaugurated  in  the  port  of  Cartagena  in  1906,  which  has  for 
object  the  treatment  of  lymphatic  and  scrofulous  children. 

Up  to  the  present  date  127  children  of  both  sexes,  from  6  to  14  years  of 
age,  have  been  treated.  The  statistical  tables  attached  to  the  last  report  prove 
the  good  results  that  have  been  obtained,  each  child  showing  a  gain  of  six 
kilograms  during  an  average  stay  of  51  days  per  child,  not  including  the 
weight  gained  by  the  natural  growth  of  each  child. 

The  Ladies  Association  Against  Tuberculosis  has  founded  in  Santiago  two 
anti-tuberculous  dispensaries.  In  the  city  of  Santa  Rosa  de  los  Andes  there 
is  a  sanatorium  for  adult  tuberculosis  patients,  which  was  founded  by  the  lady 
philanthropist,  Senora  Juana  Ross  de  Edwards.  (Annex  17.  Documents  in 
which  these  works  are  given  in  detail.) 

SANITARY   C«GANIZATION. 

The  organization  of  the  sanitary  services  in  Chile  is  due  to  the  law  of 
December  22,  1891,  which  provides  the  duties  of  the  municipal  power,  and  to 
a  constitutional  provision  (Article  73  of  the  Constitution  of  the  Republic), 
which  prescribes  that  all  public  establishments,  especially  police  matters,  shall 
be  under  the  supervision  of  the  President  of  the  Republic.  The  Municipal 
authorities  are  charged  with  the  service  of  disinfection,  vaccination,  sanitary 
police  of  animals,  hygiene  of  the  people,  supply  and  distribution  of  drinking 
water ;  sanitation  of  the  soil ;  school  hygiene ;  inspection  of  public  or  private 
slaughter-houses  and  markets;  regulation  and  inspection  of  grocery  and  wine 
stores;  sanitation  of  houses,  and  dangerous,  uncomfortable  or  unhealthy  estab- 
lishments ;  supervision  over  the  sale  of  drugs ;  regulation  of  public  establish- 
ments, hospitals,  asylums  and  cemeteries;  census  of  municipal  territories,  and 
the  organization  of  a  service  of  sanitary  inspection. 

The  municipal  authorities  have,  therefore,  the  power  to  regulate  all  branches 
of  public   hygiene,    while    the    national    authorities    have    power    only   over   the 


122  FOURTH   INTERNATIONAL   SANITARY   CONFERENCE. 

exterior  sanitary  police  and  right  of  supervision  over  the  sanitary  services. 
However,  the  law  of  1891  failed  to  invest  the  municipalities  with  sufficient 
powers  to  carry  out  such  broad  duties,  as  it  also  failed  to  provide  them  with 
sufficient  revenues  for  the  purpose,  nor  did  it  bestow  upon  the  Central  Govern- 
ment the  power  to  compel  them  to  execute  such  duties  whenever  they  neglected 
them.  For  this  reason  the  law  in  reference  has  not  succeeded  in  providing 
for  a  sanitary  administration  suitable  to  the  needs  of  the  country.  Few 
municipalities  have  proven  worthy  of  the  trust  deposited  in  them  by  the  legis- 
lators in  that  year,  with  the  exception  of  the  municipalities  of  Santiago,  Val- 
paraiso, Yquique,  Talca,  and  especially  that  of  Puntarenas,  which  has  organized 
some  of  their  sanitary  services.  The  Supreme  Government  has  had  to  take 
charge  of  the  services  of  public  disinfection,  vaccination,  supply  of  water, 
sanitation  of  towns,  hygiene  of  houses  and  schools,  regulation  of  the  sale  of 
drugs,  etc. 

Service  of  Disinfection. — The  Government  organized  this  service  in  Santiago 
in  1896.  In  1898  it  purchased  several  disinfecting  apparatuses,  on  account  of  the 
appearance  of  bubonic  plague  in  Lisbon,  which  were  immediately  distributed 
among  several  important  cities  of  the  Republic.  By  law  of  1903  the  President 
of  the  Republic  was  authorized  to  establish  and  maintain  disinfecting  stations 
in  the  cities  of  Yquique,  Antofagasta,  Coquimbo,  Serena,  Valparaiso,  San  Felipe, 
Curico,  Talca,  Chilian,  Concepcion,  Talcahuano,  Los  Angeles,  and  Valdivia. 

In  1907  there  were  in  operation  seven  disinfecting  stations.  The  rest  are  now 
being  installed. 

Vaccination  Service. — The  Government  of  the  Republic  renders  this  service 
free  of  charge  to  the  public,  through  the  Central  Board,  and  causes  the  necessary 
vaccine  to  be  prepared  in  the  Laboratory  of  Serotherapy  of  the  Institute  of 
Hygiene,  formerly  called  the  Institute  of  Animal  Vaccine. 

Supply  and  Distribution  of  Drinking  Water. — These  works  are  most  costly 
and  difficult,  and  require  the  investment  of  large  sums  of  money  and  the  em- 
ployment of  a  technical  personnel  capable  of  preparing  plans  and  supervising 
the  work  of  construction.  Almost  all  the  water  supplies  in  the  country  have 
been  built,  regulated,  maintained,  and  improved  by  the  Government.  The  fol- 
lowing water  supplies  are  in  operation : 

Fiscal. — Coquimbo,  Ovalle,  Chincolo,  Ligua,  Los  Andes,  Valparaiso,  Santiago, 
San  Bernardo,  Melipilla,  Bengo,  San  Fernando,  Curico,  Talca,  San  Javier, 
Cauquenes,  Quirigue,  Chanco,  Constitucion,  Concepcion,  Talcahuano,  Coronel, 
Los  Angeles,  Arauco,  Lebu,  Caiiete,  Angol,  Valdivia,  Vicufia,  San  Felipe, 
Linares,  and  Chilian. 

Municipal. — Tacna,  Vallenar,  Serena,  Petorca,  Putaendo,  Quillota,  Rancagua, 
Nunhue,  Yumbel,  Tome,  Puerto  Montt  and  Puntarenas. 

Private. — Yquique,  Tocopilla  and  Puntarenas. 

Improvement  works  under  construction. — San  Felipe,  San  Fernando,  Linares, 
and  Chanco. 

New  works  under  construction. — Copiapo,  Combarbala,  Quilque,  San  Jose 
de  Maipo,  Mulchen,  Collipulli  and  Victoria. 

Improvement  works,  the  studies  of  which  have  been  completed. — Molina,  Cau- 
quenes, Quirique  and  Angol. 

New  works,  the  studies  of  which  have  been  completed. — Yllapel,  Limache, 
Casablanca,  Buin,  Curepto,  Parral,  Yungay,  Concepcion,  Talcahuano,  Naci- 
miento,  Tucapel,   Temuco  and  Osorno. 

Improvement  works  under  consideration.     Vicuiia  and  Talca. 

New  works  under  consideration. — Taltal,  Los  Vilos,  La  Calera,  Peumo,  San 
Carlos,  Florida,  La  Union,  Castro.  (Annex  6,  tables  and  complete  details  in 
regard  to  most  of  these  works.) 

In  Santiago,  which  gets  its  supply  from  the  springs  of  Vitacura  and  Ramon, 
there  was  in  1908  an  average  production  that  ranged  between  55,944  cubic 
meters  in  December  and  80,821  in  the  month  of  January,  and  an  average 
consumption  from  51,430  cubic  meters  in  the  month  of  June  to  56,914  in  the 
month  of  December. 

The  length  of  the  water  pipes  in  January,  1908,  was  of  305,393.87  meters,  and 
in  January,  1909,  320,267.27  meters,  and  on  October  30th  of  the  present  year, 
337,154.22. 


FOURTH  INTERNATIONAL  SANITARY  CONFERENCE.  123 

The  average  daily  production,  during  1908,  and  the  consumption,  the  figures 
for  which  are  not  yet  available,  may  be  estimated  as  follows : 

Vitacura 36,000  M3 

Ramon 14,500  M3 

Total 50.500  M3 

The  scarcity  of  water  during  the  last  two  years  is  due  to  the  small  amount 
of  snow  falling  from  the  mountains. 

In  1908  there  initiated  in  Vitacura  the  works  for  increasing  the  produc- 
tion of  that  source,  which  works  will  be  completed  by  1910,  and  the  average 
production  of  Vitacura  will  be  of  75,000  cubic  meters  per  day,  which  added  to 
the  daily  average  production  of  the  Quebrada  de  Ramon,  of  23,000  cubic 
meters,  will  make  a  daily  average  of  98,000  cubic  meters  for  the  City  of  San- 
tiago. There  is  at  present  under  process  of  construction  a  distribution  dam  with 
a  capacity  for  40,000  cubic  meters,  the  cost  of  which  will  be  1,000,000  pesos, 
national  currency. 

SANITATION   WORKS. 

The  works  for  the  improvement  of  the  sanitation  of  cities  and  dwellings 
have  received  development  with  the  advances  attained  by  sanitary  science  in 
the  protection  of  life.  The  importance  of  those  works  is  fully  justified  by  the 
fact  that  upon  public  health  rests  the  welfare  and  progress  of  nations.  The 
construction  of  underground  air-tight  sewers  is  an  indispensable  element  for 
the  sanitation  of  the  city,  but  as  such  works  could  not  be  undertaken  by  the 
municipalities,  the  sewer  systems  of  some  of  the  most  important  cities  of  the 
Republic,  together  with  other  sanitation  works  which  will  greatly  reduce  the 
mortality  of  such  towns,  were  not  carried  out  by  the  respective  municipalities, 
but  by  the  Government  of  the  Republic. 

In  order  that  the  Bureau  which  has  under  its  charge  the  execution  of  sanita- 
tion works  might  also  have  the  supervision  over  water  supplies,  the  Supreme 
Government  decreed  that  both  Bureaus  should  be  under  control  of  the  Bureau 
of  Public  Works,  by  virtue  of  Law  No.  1835,  of  February  14,  1906. 

Sewerage  in  Santiago. — The  plans  presented  by  the  Batignolles  Fould  Com- 
pany (Proposal  B)  were  approved  on  December  27,  1904,  and  the  work  of 
construction  of  the  sewer  system  in  the  capital  was  inaugurated  on  August 
12,   1905. 

The  plan  of  that  sewer  system  is  based  upon  the  unitarian  method.  The 
project  under  execution  is  composed  of  two  separate  lines,  one  to  the  south  of 
Mapocho  River,  terminating  at  the  Zanjon  de  la  Aguada  two  and  a  half  kilome- 
ters from  the  city,  and  the  other  to  the  north  of  the  same  river,  terminating 
at  about  the  same  distance.  The  system  has  a  total  length  of  three  hundred 
and  four  meters,  and  the  cost  of  the  contract  will  be  of  16,780,000  pesos,  gold 
of  18  pence,  and  3,730,000  pesos,  national  currency,  for  the  enlargement  of  the 
water  supply  and  the  paving  of  streets.  A  careful  study  has  been  made  of 
the  distribution  of  the  system  and  the  automatic  cleaning  of  the  same,  their 
ventilation,  and  purifying  fields  to  be  used  when  the  Government  deems  it 
convenient. 

The  volume  of  liquid  that  will  be  carried  by  the  conduit  per  year  has  been 
estimated  at  120,845,358  cubic  meters,  which  would  be  sufficient  to  irrigate  a 
parcel  of  land  of  1,208  hectares,  assuming  that  each  hectare  is  capable  of  purify- 
ing 100,000  cubic  meters  of  used  water  per  year. 

Provision  has  also  been  made  for  a  sewer  system  of  sufficient  capacity  to 
conduct  waste  and  rain  waters  (Annex  7,  Report  presented  to  the  Minister  of 
the  Interior  in  regard  to  the  bidding  of  contracts  for  the  sewer  system  of 
Santiago,  by  A.  Bertrand;  documents  and  illustrations;  Brief  statement  in 
regard  to  the  work  done  by  the  technical  division  of  the  Fiscal  Bureau  of  the 
Department  of  the  Interior;  and  regulations  for  the  construction  of  sewers  in 
houses). 

The  length  of  the  canals  built  up  to  October  of  the  present  year  was  305,347 
meters;  the  number  of  accessory  works  was  3,060;  the  number  of  connections 
for  house  sewers,  etc.,  was  of  18,730;  the  conduits  in  the  southern  section  of 
the  city  already  reach  a  length  of  3,500  meters,  and  the  sewer  system  in  the 
central  part  of  the  city  is  now  in  operation. 


124  FOURTH    INTERNATIONAL   SANITARY   CONFERENCE. 

The  installations  of  sewers  in  houses,  made  in  accordance  with  regulations,, 
and  most  of  which  connected  with  the  general  system,  are  1,200,  approximately,, 
and  the  works  of  construction  of  street  sewers,  which  are  already  in  a  greatly 
advanced  state,  can  be  estimated  at  a  total  value  of  12,900,000  pesos. 

Sewerage  in  Antofagasta. — The  system  now  under  construction,  according  ta 
the  Ateaga  project  approved  by  the  Supreme  Government,  provides  for  a  sewer 
service  for  the  disposal  of  waste  water,  and  a  system  of  distribution  of  sea 
water  for  the  cleaning  of  sewers,  for  the  fire  pumps,  etc. 

One  section  of  Antofagasta  is  built  on  a  slope  at  the  foot  of  a  range  of 
mountains,  and  the  other  section  on  a  perfectly  level  ground  by  the  seashore ; 
there  are  marked  differences  between  those  two  zones,  separated  by  the  railroad 
line  from  the  point  of  view  of  the  general  sanitation  of  the  city;  both  sections 
are  separable  on  account  of  their  great  differences  of  heights  and  inclines,  the 
higher  one  having  greater  facilities  for  the  development  of  the  conduit  and 
the  drainage.  But,  if  the  separation  of  services  is  theoretically  more  perfect,, 
one  smgle  system  is  practically  more  desirable. 

The  plan  of  the  city  make  the  zig-zag  system  of  sewers  preferable  to  any 
other. 

The  cost  of  the  Ateaga  project  is  as  follows: 

Pesos  gold  of  18d. 

Sewer  system $397,198.08 

Cleaning   service    42,273.70 

Distribution   service    192,102.90 

According  to  estimates  made  by  the  engineers,  the  cost  of  elevating  the  water 
from  the  sea  will  be  ten  cents  per  cubic  meter,  an  insignificant  amount  in 
comparison  to  the  price  of  drinking  water,  and  the  supply  of  sea  water  is  of 
75  daily  liters  per  inhabitant,  a  sufficient  quantity  that  will  ensure  the  good 
operation  of  the  sewer  system  and  of  the  other  services  which  I  have  mentioned. 
(Annex  8,  plans,  specifications,  etc.) 

Sewerage  in  Talca. — The  project  for  the  sanitation  of  the  City  of  Talca  com- 
prises the  three  following  parts :  Sewerage,  pipe  line  for  the  clearing  of  the 
sewerage,  and  deviation  of  the  Baeza  Creek. 

The  sewer  system  will  be  on  the  zig-zag  plan ;  the  same  waters  that  now 
supply  the  canals  of  the  city  for  cleaning  the  sewerage  lines,  establishing  for 
this  purpose  a  special  system  of  pipes  for  the  continuous  washing  of  sewers. 

The  Baeza  Creek,  which  traverses  the  most  densely  populated  district  of  the 
city  and  which  receives  not  only  the  waters  from  the  canals,  but  also  the 
refuse  from  the  neighboring  houses,  would,  after  the  completion  of  the  sewer 
system,  be  a  source  of  infection  for  the  city.  For  this  reason  the  Grovernment 
has  decided,  as  the  best  and  cheapest  solution,  to  deviate  the  course  of  that 
creek,  so  as  to  make  it  empty  into  the  Claro  River. 

The  City  Talca  gets  its  supply  of  water  from  the  Baeza  Mountain,  and  work 
is  now  in  progress  to  enlarge  that  supply  so  that  it  may  furnish  100  liters  per 
inhabitant  every  24  hours. 

The  present  population  of  the  City  of  Talca  is  estimated  at  40,000  inhabitants, 
but  as  the  sewerage  system  will  be  built  for  a  period  of  not  less  than  sixty 
years,  they  have  been  planned  upon  a  basis  of  80,000  inhabitants.  (Annex 
9,  plan  of  the  city  and  of  the  sanitation  works.) 

Sewerage  in  Curico. — The  City  Curico  has  a  population  of  about  15,(XX)  in- 
habitants ;  the  sewer  works  have  been  planned  upon  a  basis  of  a  much  larger 
population. 

The  project  includes  a  line  of  unitary  system  which  stretches  towards  the 
part  of  the  city  comprised  in  the  Alameda,  Avenida  Camilo  Henriquez,  Calle 
O'Higgins,  and  Calle  San  Martin ;  for  the  future  enlargement  of  the  system, 
part  of  the  city  to  the  east  of  the  Alameda,  and  part  to  the  north  of  the 
Avenida  Camilo  Henriquez,  have  been  taken  into  consideration,  each  to  be 
provided  with  a  separate  system. 

The  zig-zag  plan  was  first  tried,  but  on  account  of  the  slight  declivity  of  the 
ground  it  was  decided  to  adopt  the  rectangular  system.  The  ventilation  of  the 
system  is  made  by  means  of  inspection  chambers  and  the  house  connections. 
The  washing  of  the  sewers  is  continuous  in  all  the  principal  pipes,  and  inter- 
mittent in  all  the  secondary  ones.     (Geneste-Hersscher  washers.) 

The   appropriation   for  these  works  amounts  to  426,000  pesos   gold   of   ISd. 


FOURTH  INTERNATIONAL  SANITARY  CONFERENCE.  125 

(Annex  10,  complete  specifications  of  the  project  and  plan  of  the  city,  with  the 
distribution  of  the  sewer  system.) 

Sewerage  in  Chilian. — The  City  of  Chilian  needed,  perhaps  more  than  any 
other  town,  this  most  important  service,  on  account  of  the  almost  absolute  lack 
of  canals  that,  even  though  imperfectly,  would  take  the  place  of  sewerage,  and 
the  inhabitants  were  compelled  to  use  the  primitive  system  of  open  wells. 
Through  the  southern  part  of  Chilian  runs  the  Las  Toscas  Creek,  the  depth  of 
which  is  five  meters ;  Chilian  is  an  exceptionally  level  and  regular  city. 

The  separate  system  has  been  adopted,  because  otherwise  there  would  not 
have  been  sufficient  water,  on  account  of  the  conditions  of  the  locality,  for  the 
washing  of  the  sewers  on  the  unitary  system.  The  zig-zag  plan,  which  would 
have  provided  for  the  continuous  washing  of  the  sewers,  could  not  be  adopted 
on  account  of  the  slight  declivity  of  the  ground.  The  system  adopted  is  best 
suited  for  the  city.  The  necessary  water  for  the  cleaning  of  the  system  is 
taken  from  the  municipal  canal,  for  which  purpose  the  necessary  plant  has  been 
constructed  in  the  grounds  of  the  Agricultural  Station. 

The  total  appropriation  for  these  works  amounts  to  960,000  pesos  gold  of  18d. 
(Annex  11,  complete  specification  and  details  of  the  project  and  plans  of  the 
city  showing  the  distribution  of  the  sewerage  system.) 

Sczverage  in  Concepcion. — These  works  were  under  construction  in  accord- 
ance with  the  project  approved  by  the  Government,  and  presented  by  the 
English  Company,  but  some  modifications  had  to  be  made  lately,  which  are  still 
being  established,  and  for  this  reason  I  do  not  give  any  details  in  regard  to 
them.     (Annex  12,  general  plan  of  the  sewer  and  water-supply  systems.) 

Sewerage  in  Los  Angeles,  in  Laserena,  San  Felipe,  Teniuco,  Valdivia,  and 
Taltal. — The  projects  for  these  works  are  almost  completed,  and  they  will  be 
ready  in  1910.  (Annex  13,  specifications  for  the  construction  of  sewers  in  the 
Republic;   regulations  governing  contracts  for  public  works.) 

HYGIENE  OF  HOUSES. 

,  The  government  has  also  been  placed  in  the  necessity  of  taking  care  of  this 
branch  of  public  health,  and  by  Law  of  February  20,  1906,  a  Council  on  Houses 
for  Workingmen  was  constituted,  which  prepared  the  regulations  regarding 
dwellings  of  laborers,  approved  by  the  Government  in  September  of  the  same 
year. 

For  the  purpose  of  building  sanitary  houses  for  the  people,  in  substitution 
for  the  unhealthy  ones  that  will  have  to  be  torn  down,  the  Supreme  Council 
on  Houses  secured  authorization  from  the  Government,  under  the  Law  of 
July  16,  1907,  to  negotiate  a  loan  of  6,000,000  pesos,  guaranteed  by  the  Gov- 
ernment. 

The  Government  has  under  consideration  the  regulations  for  that  law,  and 
the  Council  on  Houses  is  preparing  the  regulations  for  the  administration  of 
workmen's  houses.  In  Santiago  there  have  been  demolished  several  unhealthy 
houses,  others  have  been  repaired,  and  several  private  dwellings  for  laborers 
have  been  approved  as  sanitary.  All  the  Departmental  Councils  on  Houses 
have  been  organized  in  the  capitals  of  Provinces,  and  in  the  capitals  of  the 
Departments  of  Quillota,  Limache,  Coquimbo,  Constitucion,  San  Carlos,  Tome, 
Ovalle,  and  another  one  will  be  established  in  Talcahuano.  In  this  respect 
private  initiative  took  the  lead,  and  for  some  years  we  have  had  workingmen's 
settlements  in  the  capital,  such  as  those  of  Leon  XIII,  Pio  IX,  Ovalle,  and 
others. 

SCHOOL    HYGIENE. 

The  Government  has  now  charge  of  the  school  hygiene,  which  is  under  the 
supervision  of  the  Department  of  Public  Instruction. 

SUPERVISION   OVER   THE    SALE  OF   DRUGS. 

After  this  date  the  Municipalities  have  made  very  little  use  of  the  powers 
vested  in  them  by  the  Law  of  1891,  and  the  drug  stores  and  apothecaries  have 
been  governed  by  the  regulations  enacted  by  the  Executive  Power,  in  pursuance 
of  the  laws  of  January  9,  1879,  and  July  15,  1871.  The  Budget  Law  of  1897 
created  the  Commission  for  the  Inspection  of  Drug  Stores,  under  the  super- 
vision of  the  Supreme  Council  of  Public  Hygiene. 


126  FOURTH    INTERNATIONAL   SANITARY    CONFERENCE. 

CENTRAL  AUTHORITY  OF  THE  GOVERNMENT. 

The  President  of  the  Republic  has  supreme  inspection  over  all  police  matters. 
According  to  our  Legislation  only  one  branch  of  public  hj'giene,  the  Exterior 
Police,  is  absolutely  controlled  by  the  Executive  Power ;  everything  else  js 
under  the  exclusive  charge  of  the  municipal  authorities. 

The  President  of  the  Republic  appoints  the  harbor  physicians  and  the  per- 
sonnel for  the  only  sanitary  station  that  we  have  in  the  country,  which  officers 
are  charged  with  the  duty  of  enforcing  the  maritime  health  regulations.  The 
President  also  appoints  the  personnel  for  land  sanitary  stations  wherever  they 
are  established.  He  exercises  also  active  intervention,  on  special  occasions,  in 
the  public  health  of  cities,  or  in  cases  of  contagious  epidemics,  by  virtue  of  the 
Sanitary  Police  Law  of  December  30,   1886. 

Outside  of  the  services  which  we  have  just  enumerated  the  Executive^  has  no 
power  to  interfere,  unless  it  be  to  exercise  the  right  of  supreme  inspection. _  In 
order  to  advise  on  sanitary  matters  the  law  has  created,  under  the  Minister 
of  the  Interior,  a  Supreme  Council  of  Public  Hygiene  as  an  Advisory  Board; 
to  advise  the  Governors  on  similar  matters  a  Supreme  Decree  has  organized  the 
Departmental  Councils  of  Hygiene.  On  January  25,  1907,  a  Division  of  Hygiene 
and  Public  Beneficence,  under  the  Minister  of  the  Interior,  was  created.  The 
Law  of  September  28,  1898,  organized  Sanitary  Inspection  of  the  Republic,  as  a 
division  of  the  Superior  Council  of  Public  Hygiene.  The  Institute  of  Hygiene, 
also  a  division  of  the  Supreme  Council,  was  organized  by  Law  of  September  15, 
1892 ;  it  is  composed  of  five  sections,  to  wit :  Hygiene  and  Dernography ;  Chem- 
istry;   Microscopy;    Bacteriology;    Serotherapy,    and   Disinfection. 

This  Institute  publishes  the  Review  of  Hygiene,  and  the  Bulletin  of  Hygiene 
and  Dem.ography.  (Annex  14,  collection  of  these  publications  in  which  are 
described  the  services  that  that  Institute  renders  to  the  public.) 

Sanitary  Station  of  Arica. — This  Sanitary  Station  receives  continuously  re- 
ports by  means  of  which  it  is  kept  informed  on  the  sanitary  condition  of  the 
neighboring  nations.  It  has  a  recently  built  lazaretto,  equipped  with  laborato- 
ries, a  library,  etc.  This  sanitary  station  is  governed  by  the  regulations  ap- 
proved by  the  Supreme  Government  on  August  13,  1908.  (Annex  15,  regula- 
tions for  the  Sanitary  Station,  and  National  Sanitary  Laws,  relating  to  inter- 
national prophylaxis.)  ■      ,  ,  n^A 

In  1908  the  Sanitary  Station  disinfected  150  vessels  and  exammed  1,364  mem- 
bers of  crews  and  7,137  passengers.  Only  four  vessels,  arrived  from  Kongkong 
with  Trachoma  and  Beri-Beri,  were  placed  under  quarantine. 

It  is  provided  with  a  steam  launch  with  a  Clayton  apparatus  and  an  ambulance 
wagon.  (See  Annex  3,  complete  details  in  regard  to  the  Sanitary  Station 
and  its  lazaretto,  photographs,  etc.) 

PUBLIC  BENEFICENCE  IN   CHILE. 

The  organization  of  this  service  is  due  to  the  protective  power  vested  by 
the  Political  Constitution  of  the  Republic  in  the  President,  although  up  to  the 
present  date  no  organic  law  has  been  passed  in  regard  thereto.  It  is  in  regard 
to  these  branches  of  public  health  and  welfare  that  the  action  of  the  Govern- 
ment has  been  most  efficient. 

Almost  all  the  hospitals  and  asylums  in  the  country  were  founded  by  the 
Government ;  it  is  the  Government  who  takes  care  and  treats  the  insane 
people;  it  is  the  Government  who  protects  the  homeless  children,  caring  for 
them  in  Orphan  Asylums  which  it  supports  by  means  of  liberal  appropriations. 
Item  11  of  the  appropriation  for  the  Department  of  the  Interior  for  the  year 
1908  assigns  the  sum  of  4,121,800  pesos  for  hospitals  and  asylums,  and  791,161 
pesos  for  buildings  to  be  devoted  to  such  purposes.  (Annex  16,  organization  of 
Public  Beneficence  in  Chile,  and  especially  of  Santiago.) 

NEW  SANITARY  CODE. 

The  principal  aim  of  the  Government  is  the  organization  of  a  Central  Bureau 
of  Public  Health,  having  executive  control  over  the  sanitary  services  of  the 
coimtry.  Doctors  Mariano  Guerrero,  Lucio  Cordova,  member  and  secretary, 
respectively,  of  the  Supreme  Council  of  Health,  were  sent  to  foreign  countries 
for  the  purpose  of  stuyding  the  most  modern  sanitary  services  adapted  to  our 


FOURTH  INTERNATIONAL  SANITARY  CONFERENCE.  127 

country,  and  they  have  recently  submitted  a  sanitary  code  which  provides 
for  all  our  needs,  and  which  I  now  have  the  honor  to  submit  to  you.  Doctors 
Ramon  Corvalan  Mergarejo,  Acting  President  of  the  Supreme  Council  of 
Hygiene,  and  Paulino  Alfonso,  a  member  thereof,  and  both  members  of  the 
House  of  Deputies,  have  prepared  a  bill  for  a  sanitary  code  which  differs  from 
the  former  in  that  it  diminishes  the  powers  of  the  Director-General  of  Health 
and  increases  those  of  the  Supreme  Council  of  Hygiene.  This  bill  I  also  have 
the  honor  to  submit  to  you. 

The  keen  interest  of  the  President  of  the  Republic  in  carrying  out,  as  soon 
as  possible,  one  of  these  two  projects,  has  moved  him  to  appoint  a  commission 
of  senators,  deputies,  members  of  the  Superior  Council  of  Hygiene,  and  re- 
nowned hygienists  to  study  these  projects  and  to  submit  as  soon  as  possible 
to  the  approval  of  the  Legislature  the  one  that  may  be  deemed  the  most  suitable. 
We  are,  therefore,  animated  by  the  desire  to  reform  our  present  sanitary 
service  so  that  we  may  have  a  more  perfect  one,  which  should  be  in  conformity 
with  the  latest  achievements  of  hygiene  and  public  health.  (Annex  17,  both 
projects.) 


FOURTH  INTERNATIONAL  SANITARY  CONFERENCE.  129 

REPORT  OF  DR.  MARTIN  AMADOR,  DELEGATE  FROM 

COLOMBIA. 

Messrs.  Delegates :  Having  been  absent  from  Colombia  for  several  years, 
and  having  been  appointed  as  its  delegate  before  this  assembly  scarcely  seven 
days  ago,  my  report  must  necessarily  be  laconic  and  deficient,  by  reason  both 
of  the  lack  of  time  and  of  data  regarding  the  sanitary  conditions  of  that 
rich  country. 

The  Government  has  always  given  preferential  attention  to  public  health, 
and  more  especially  to  the  sanitation  of  ports  on  the  Atlantic  and  the  Pacific, 
and  to  it  is  due  to  a  large  extent  the  fact  that  foreigners  visit  the  country 
without  fear,  and  the  constant  decrease  of  mortality  therein. 

The  disturbances  through  which  the  country  has  undergone  during  the  last 
two  years,  even  though  now  the  Government  is  earnestly  devoted  to  the  mainte- 
nance of  peace  and  order — which  are  the  aspiration  of  all  countries  striving  to 
advance  in  the  path  of  civilization  and  progress — have,  so  far  as  I  am  informed, 
handicapped  the  legislation  in  regard  to  the  subjects  decided  upon  by  the  last 
Sanitary  Congress. 

Nevertheless,  the  operation  of  the  Boards  of  Health  has  been  very  efficient 
throughout  the  country,  particularly  in  the  ports  where  the  diseases  prevailing 
in  tropical  climates  have  been  successfully  fought. 

In  towns,  like  Cartagena,  where  formerly  the  supply  of  water  was  obtained 
from  wells  and  tanks — which  might  be  properly  called  breeding  places  for  mos- 
quitoes— health  has  advanced  noticeably,  thanks  to  the  building  of  aqueducts, 
which  now  furnish  a  pure  and  healthful  liquid,  entirely  free  from  germs.  To 
that  fact  is  due  the  almost  complete  disappearance  of  sporadic  cases  of  yellow 
fever  that  used  to  occur  among  the  inhabitants  of  the  highlands. 

Colombia  has  up  to  the  present  date  been  free  from  bubonic  plague,  in  spite 
of  the  fact  that  some  of  the  neighboring  countries  had  been  invaded  by  that 
disease.  This  result  is  due  to  the  timely  measures  adopted  by  the  Government, 
which  also  provided  itself  with  a  goodly  number  of  Clayton  apparatus  and  great 
quantities  of  anti-plague  serum — the  Government  being  always  ready  to  fight 
the  epidemic  and  to  protect  the  ports  against  infection. 

I  will  now  report  upon  the  presence  of  leprosy  in  Colombia,  and  upon  the 
measures  taken  by  the  Government  for  the  isolation  of  the  patients  and  the 
prevention  of  the  spread  of  the  disease. 

The  following  data  has  been  taken  from  the  report  presented  by  the  Minister 
of  the  Interior  to  the  National  Constituent  and  Legislative  Assembly,  under 
date  of  July  20,  1908;  this  report  is  really  meritorious  because  the  Minister 
that  prepared  it  was  for  over  ten  years  in  charge  of  that  branch,  and  Governor 
of  the  two  Departments  which  had  suflfered  most  from  the  attacks  of  that 
dreadful   scourge. 

There  are  three  leper  colonies  in  the  country,  to  wit :  Ag^a  de  Dies,  Contra- 
tacion,  and  Cano  del  Oro,  the  first  of  which  has  sixteen  hundred  patients,  and 
to  it  are  sent  the  patients  from  eight  Departments. 

The  proportion  of  persons  afflicted  with  the  disease  is  less  than  one  per 
thousand,  which  shows  that  the  country  has  but  one-sixth,  at  most,  of  the 
number  of  lepers  usually  attributed  to  it. 

Indeed,  the  population  of  Colombia  may  be  estimated  at  five  million  in- 
habitants, whereas  the  total  of  lepers  is  only  four  thousand  six  hundred  and 
thirty-nine. 

At  present,  over  fifty  per  cent  of  the  lepers  are  isolated  in  the  diflferent 
lazarettos. 

Before  the  patients  are  admitted  to  the  colonies,  they  are  subjected  to  a 
clinical  and  bacteriological  examination,  in  order  to  prevent  in  the  colonies  the 
admission  of  persons  suffering  from  another  disease.  Even  since  that  examina- 
tion was  started,  three  hundred  and  twenty-four  individuals  who  had  been 
erroneously  confined  in  the  lazarettos  have  been  discharged. 

Formerly  the  Government  was  able  to  isolate  but  fourteen  per  cent  of  the 
total  number  of  lepers  in  the  country;  during  the  last  five  years  it  isolated, 
as  I  have  said,  over  fifty  per  cent.  We  will,  therefore,  soon  be  able  to  control 
and  eradicate  the  scourge,  as  several  European  nations  have  been  able  to  do,  by 
means  of  isolation. 


130  FOURTH    INTERNATIONAL   SANITARY   CONFERENCE. 

There  have  been  opened  in  the  Agua  de  Dios  colony  three  modern  pavilions, 
with  capacity  for  two  hundred  and  fifty  patients;  an  asylum  for  orphan 
girls;  another  for  boys;  an  aqueduct — perhaps  the  most  important  work  of  its 
kind  in  the  country — which,  taking  the  water  from  the  Bogota  River,  carries 
it  by  means  of  battery  rams  to  a  height  of  65  meters  through  steel  tubes  seven 
inches  in  diameter  and  4,200  meters  in  length,  furnishing  each  one  of  the 
three  thousand  patients  that  can  be  lodged  in  the  colony  with  one  hundred 
and  twenty  liters  of  water  per  day;  an  asylum  for  healthy  children  born  of 
lepers  isolated  in  the  colonies ;  and  three  more  pavilions  with  a  capacity  for 
three  hundred  patients. 

The  medical  service,  as  the  report  in  reference  says,  is  complete  and  is  done 
under  the  control  of  three  notable  physicians,  two  of  whom  are  bacteriologists. 

Another  of  the  measures  enforced  to  prevent  the  propagation  of  leprosy  is  the 
coinage  of  a  special  metallic  money  for  circulation  within  the  radius  of  the 
colonies,  which  facilitates  the  transaction  of  business  among  the  patients.  In 
order  that  the  patients  may  fully  enjoy  their  civil  rights,  there  have  also  been 
established  in  the  colonies  several  courts  of  justice.  The  first  of  these  measures 
has  principally  for  object  to  protect  public  hygiene  by  avoiding  the  use  by 
healthy  people  of  money  employed  by  lepers,  and  at  the  same  time  placing 
no  ban  whatever  upon  business  transactions  in  the  colonies ;  and  the  second 
measure  facilitates  isolation,  guaranteeing  at  the  same  time  the  personal  rights 
of  all  the  patients. 

The  supreme  control  of  the  leper  colonies  has  been  intrusted  to  the  Govern- 
ment of  the  Republic  since  1905 ;  the  government  has  given  them  a  uniform 
organization  and  empowered  the  Governors  of  the  Departments  in  which  said 
colonies  are  located  to  inspect  them  for  the  purpose  of  enforcing  all  the  measures 
enacted  for  the  safeguard  of  the  community  and  the  prevention  of  contagion. 

The  most  modern  treatments  employed  in  Europe  and  recommended  by 
science  have  been  adopted  in  our  different  colonies.  Recently,  in  view  of  the 
promising  results  obtained  by  Professor  Unna,  a  diplomatic  agent  of  the 
Republic  was  intrusted  with  the  special  mission  of  making  a  careful  study 
of  the  treatment  discovered  by  that  distinguished  leprologist,  and  of  securing 
from  him  personally  the  necessary  instructions  for  the  establishment  in  the 
colonies  of  the  nation  of  the  cure  which  that  professor  advocated  before  the 
International  Medical  Congress  of  Lisbon. 

I  regret,  gentlemen,  my  inability  to  report  upon  the  other  topics  included 
in  the  programme  previously  agreed  upon  for  this  Congress,  but,  as  I  said 
before,  the  lack  of  time  and  of  data  compel  me  to  make  this  report  a  short  one, 
and  to  confine  it  to  the  last  two  years. 

But  my  willingness  to  co-operate  with  you  is  great,  and  I  am  sure  that  your 
labors  will  be  fruitful  in  benefits  for  the  countries  of  America,  and  I  shall 
take  particular  pains  in  informing  the  Government  of  Colombia  with  regard  to 
such  resolutions  as  may  be  passed  by  this  scientific  assembly. 


FOURTH  INTERNATIONAL  SANITARY  CONFERENCE.  131 

REPORT  PRESENTED  BY  THE  DELEGATION  OF  THE 
REPUBLIC  OF  COSTA  RICA,  COMPOSED  BY  DOCTORS 
JUAN  J.  ULLOA,  PRESIDENT;  CARLOS  DURAN,  ELIAS 
ROJAS,  AND  JOSfi  M.  SOTO,  SECRETARY. 

I. 

SANITARY  MEASURES  AND  LAWS   IN  FORCE  IN  THE  COUNTRY. 

Public  hygiene  is  attaining  every  day  a  greater  importance  among  us,  as  a 
practical  science  of  constant  use  and  as  an  institution  destined  to  strengthen 
and  widen  our  wealth,  through  the  transcendental  effects  which  it  exercises 
upon  the  development  of  social  welfare. 

It  is  true  that  in  this  respect  we  have  not  made  the  same  progress  attained 
in  other  branches ;  but  what  has  already  been  done,  together  with  the  proba- 
bility, founded  upon  powerful  reasons,  that  in  no  time  shall  we  abandon  the 
task  that  has  been  undertaken,  are  circumstances  which  enable  us  to  predict, 
with  the  utmost  confidence,  a  better  epoch  for  public  health  and  a  progressive 
activity  in  our  sanitary  improvement. 

Private  initiative,  wisely  promoted  by  scientific  propaganda,  and  the  efficient 
action  of  the  .Government,  will  give  us  within  a  short  period  the  position  that 
belongs  to  us  in  the  concert  of  civilized  nations,  from  the  point  of  view  of 
hygiene   and   sanitation. 

In  Costa  Rica,  as  is  the  case  in  many  countries  of  the  American  Continent, 
we  have  not  as  yet  a  true  sanitary  legislation.  The  principles  and  provisions 
of  this  nature  are  scattered  in  different  laws,  and  several  of  them  are  inefficient, 
on  account  of  the  lack  of  effective  sanction  that  would  prevent  the  inhabitants 
from  evading  their  compliance,  thus  rendering  void,  to  a  certain  extent,  the 
rigor  with  which  such  duties  should  be  invested,  and  relaxing  also  the  zeal 
of  the  authorities. 

Therefore,  it  is  imperative,  as  a  measure  of  urgent  necessity,  to  adopt  a 
sanitary  code,  based  upon  the  principles  of  modern  sanitary  science  and  upon 
those  recommended  by  the  International  Sanitary  Conferences  of  the  American 
Republics  for  the  purpose  of  establishing  for  the  new  world  an  International 
Sanitary  Code. 

It  may  be  a  difficult  task,  but  it  is  indispensable  that  we  should  undertake 
it  as  soon  as  possible.  Besides,  there  is  already  a  working  basis  for  the 
deliberations  of  our  legislators:  we  refer  to  the  project  for  a  sanitary  code 
prepared  by  the  Faculty  of  Medicine  and  Surgery,  which  should  be  discussed 
without  any  delay,  and  to  this  end  shall  be  directed  the  efforts  of  the  Recess 
Committee  to  be  appointed  by  the  present  Fourth  Conference,  and  with  which 
we,  the  members  of  the  Delegation  of  Costa  Rica,  shall  co-operate  with  all  our 
might,  personally  binding  ourselves  to  do  so. 

A  serious  question  arises  in  regard  to  the  subject;  and  that  is,  that  the  order 
of  ideas  in  which,  by  reason  of  its  peculiar  character,  sanitary  legislation  of 
to-day,  should  be  inspired,  is  sometimes  in  open  conflict  with  the  general 
political  order,  especially  with  civil  law  and  with  some  principles  of  public 
law ;  for  this  reason  the  establishment  of  a  severe  and  firm  sanitary  regime 
in  the  country  will  be  difficult  so  long  as  the  legislative  power  does  not  over- 
come that  obstacle,  harmonizing  the  sacred  interests  of  hygienic  science  with 
those  of  judicial   life   of  the   community. 

In  consequence,  we  believe  that  at  the  opportune  moment  and  by  means 
of  an  ample  and  impartial  discussion  greater  efforts  shall  be  made  to  find  a 
satisfactory  solution,  which  will  protect  at  the  same  time  the  rights  of  public 
and  personal  liberty  and  those  of  the  most  important  administration  of  public 
health,  the  supreme  law  of  nations,  under  whose  redeeming  protection  human 
existence  is  ennobled  and  strengthened,  social  welfare  is  fulfilled  without  reserve 
and  the  wealth  of  the  people  increased,  saving  lives,  pushing  progress  upon  the 
basis  of  physical  resistance  which  is  at  the  same  time  the  principle  of  the  intel- 
lectual and  moral  advance  of  society,  and  considerably  promoting  the  great 
activities  of  labor. 


132  FOURTH    INTERNATIONAL   SANITARY   CONFERENCE. 

The  sanitary  laws  of  Costa  Rica  are  of  two  kinds:  national  and  municipal. 

Among  the  former  we  have  the  following: 

First,  several  provisions  in  regard  to  public  hygiene,  contained  in  the  Penal 
Code  of  1881 ;  second,  other  provisions  contained  in  full  General  Regulations 
of  Police,  of  1849;  third,  the  International  Sanitary  Convention  signed  at  Wash- 
ington on  October  14,  1905,  and  approved  by  our  Constitutional  Congress  in 
the  regular  sessions  of  1906;  fourth,  the  law  of  town  physicians,  of  October  30, 
1894 ;  fifth,  the  law  on  venereal  prophylaxis,  of  July  28,  1894,  partly  in  force ; 
sixth,  law  regulating  the  practice  of  medicine,  of  August  12,  1902  (No.  73)  ; 
seventh.  Pharmacy  Law  of  August  12,  1902  (No.  74);  eighth,  law  regulating 
the  introduction  and  sale  of  opium,  morphine,  and  its  alkaloids,  of  January 
9,  1907. 

Besides  the  above,  there  are  several  articles  relating  to  special  subjects  of 
hygiene,  to  which  we  shall  make  reference  elsewhere  in  this  report,  and  which 
are  scattered  in  different  laws. 

The  municipal  regulations  in  force  within  the  respective  jurisdiction  of  the 
different  municipalities  are  subject  to  the  principles  of  the  municipal  ordinances. 

These  regulations  refer  to  buildings,  tenement  houses,  dairies  and  stables, 
slaughter-houses,  destruction  of  dogs,  public  bath-houses,  meat  markets,  sewers, 
organic  refuse,  sanitary  beneficence,  cleanliness  of  towns,  cemeteries,  vaccina- 
tion, markets,  etc. 

In  regard  to  the  first  subject  of  the  Programme  of  the  Conference  we  have 
to  report  that,  after  the  Conference  of  Mexico,  held  in  the  latter  part  of  Decem- 
ber, 1907,  the  Government  of  the  Republic  has  enacted  two  provisions  which 
are  extremely  useful  to  the  interests  of  hygiene ;  an  executive  resolution,  during 
the  fiscal  year  1907-8,  ordering  town  physicians  to  keep  special  registers  of 
vaccination,  hygiene,  treatment  of  patients,  and  medico-legal  service.  In  the 
register  of  hygiene  the  following  subjects  must  be  recorded,  by  means  of 
numbered  entries :  The  result  of  the  observations  made  by  physicians  in  regard 
to  diseases  prevailing  in  places  under  their  jurisdiction;  time  of  their  appear- 
ance; their  causes  and  means  of  preventing  them,  making  mention  of  the  method 
of  prophylaxis  advised  by  the  official  to  the  police  authorities  for  the  extermina- 
tion of  said  diseases;  any  causes  of  mortality  in  children;  the  visits  of  inspec- 
tion in  places  where  articles  of  daily  consumption  are  sold,  and  in  markets, 
hotels,  inns,  and  drug  stores;  the  result  of  said  inspections,  and  the  date  on 
which  they  were  made. 

The  said  resolution  makes  it  also  the  duty  of  those  officials  to  send  within 
the  first  five  days  of  each  month  to  the  Department  of  Police  a  report  on  the 
services  rendered  by  them  and  on  everything  concerning  the  health  conditions 
of  the  respective  circuits  during  the  previous  months.  These  measures  are  of 
indisputable  practical  significance  and  for  this  reason  we  make  mention  of 
them. 

The  second  provision  to  which  we  refer  is  that  approving  the  contract  entered 
into  between  the  Department  of  Police  and  Drs.  Carlos  Pupo  and  Luis  Paulino 
Jimenez,  and  the  establishment  of  a  laboratory  for  bacteriological  and  micro- 
scopical examinations  of  food  products  and  pathological  substances;  for  the 
preservation  of  serums  and  vaccines  introduced  by  the  Government;  and  to 
render  free  services  to  the  health  authorities  and  to  indigent  persons  ap- 
plying thereto. 

'  It  is  not  necessary  to  praise  the  benefits  that  we  are  to  derive  from  this 
laboratory ;  we  shall,  therefore,  confine  ourselves  to  report  that  it  has  already 
been  opened  to  the  public  and  that  the  country  Is  now  provided  with  this  new 
element,  favorable  in  every  respect  to  the  cause  of  hygiene. 

Finally,  we  beg  leave  to  express  in  this  chief  chapter  a  vote  of  praise  for  the 
administration  so  worthily  presided  over  by  Senor  Licenciado  Don  Cleto  Gon- 
zaleT:  Viquez,  one  of  our  foremost  hygienists,  for  the  zeal  with  which  he  has 
administered  during  his  term  to  all  subjects  relating  to  public  health,  to  which 
he  has  always  given  pre-eminent  attention,  in  the  midst  of  his  numberless  duties. 
Public  health  has  yet  much  to  expect  from  his  talent  and  activity,  he  being,  as 
he  has  always  been,  one  of  the  most  active  champions  of  all  humanitarian 
propaganda  in  Costa  Rica. 


FOURTH  INTERNATIONAL  SANITARY  CONFERENCE.  133 

II. 

COMPLIANCE  WITH  THE  RESOLUTIONS  ADOPTED  IN  PREVIOUS 

CONFERENCES. 

With  reference  to  this  subject  we  beg  to  report  that  vaccination  against 
smallpox  is  compulsory  in  the  country,  and  that  it  is  practiced  with  due  fre- 
quency, especially  among  school  children.  The  health  officials  devote  their  un- 
divided attention  to  this  service,  the  results  of  which  are  most  satisfactory. 

The  Department  of  Police  receives  every  month  250  tubes  of  Swiss  vaccine 
and  distributes  them  discretionally  among  the  medical  officers  of  the  Depart- 
ments. When,  in  February  of  this  year,  a  smallpox  epidemic  broke  out  in 
Honduras,  the  necessary  preventive  measures  were  immediately  enforced,  on 
account  of  the  danger  of  infection  due  to  the  relative  proximity  of  the  foci  of 
infection,  when  that  Department  made  an  extraordinary  order  for  5,000  tubes, 
and  vaccination  and  revaccination  was  effected  throughout  the  Republic  regard- 
less of  age.  Happily,  the  danger  was  overcome,  but,  nevertheless,  the  preventive 
measures  against  smallpox  are  persevering  among  us. 

In  regard  to  malaria,  which  causes  so  much  ravage  in  the  Atlantic  littoral, 
the  scientific  campaign  is  active  in  the  country.  The  Government  has  widely 
distributed  several  publications  for  the  purpose  of  popularizing  the  most  inter- 
esting points  in  regard  to  the  cause,  prevention,  and  treatment  of  said  disease. 
Among  those  publications,  the  following  are  worthy  of  mention  :  *'The  Study  of 
Malaria,"  by  Dr.  Ronald  Ross,  translated  into  Spanish  by  Dr.  T.  H.  Calnek  and 
Luis  P.  Jimenez;  and  "Instructions  for  the  Destruction  of  Mosquitoes,  Espe- 
cially the  Yellow  Fever  Mosquito,"  by  Dr.  W.  C.  Gorgas,  translated  into  Spanish 
by  Sehor  Licenciado  Don  Cleto  Gonzalez  Viquez. 

We  attach  utmost  importance  to  the  advisability  of  declaring  free  of  fiscal 
■duties  quinine  salts,  fine-mesh  wire  and  gauze  used  for  protection  against  mos- 
quitoes, crude  petroleum,  ready-made  mosquito  netting,  and  such  products  as 
are  used  in  the  manufacture  thereof;  as  well  as  the  establishment  of  centers 
for  the  free  distribution  of  quinine  to  the  poor  for  the  prophylaxis  of  malaria 
in  places  where  the  disease  is  prevalent.  And  we  trust  that  such  recommenda- 
tions of  the  Conference  of  Mexico  will  soon  be  officially  adopted  in  the 
Republic. 

In  regard  to  immigration,  we  have  good  protective  laws.  The  introduction 
in  our  territory  of  persons  suffering  from  leprosy,  bubonic  plague,  yellow 
fever,  and  other  diseases,  which  in  the  opinion  of  the  sanitary  authorities  may 
be  contagious,  is  prohibited. 

Since  1897  the  immigration  of  Chinese  is  absolutely  prohibited,  as  is,  also, 
since  1904,  that  of  Turks,  Assyrians,  Armenians,  and  gypsies  of  any  nationality, 
as  a  protective  means  against  the  physiological  degeneration  of  the  race,  and 
the  introduction  of  Oriental  diseases. 

By  a  decree  of  the  1st  instant,  the  legislative  power  has  approved  a  railroad 
law  which  is  already  in  force.  It  authorizes  the  department  of  promotion 
to  compel  the  railroad  companies  to  comply  with  the  regulations  on  the  police 
and  proper  administration  of  the  service  in  everything  effecting  the  safety  of 
persons.  The  Government  is,  therefore,  in  a  position  to  include  in  those  regula- 
tions the  recommendations  made  by  the  previous  Conference  in  regard  to  the 
hygiene  of  railroad  traffic. 

In  regard  to  tuberculosis  and  to  the  prophylaxis  of  other  contagious  diseases 
specified  in  the  Programme,  we  shall  give  details  when  we  dwell  upon  them  in 
particular  in  another  chapter  of  this  report. 

The  Convention  of  Washington  of  1905  has  been  faithfully  complied  with 
in  Costa  Rica. 

By  decree  of  April  23,  1908,  the  Port  of  Limon  was  closed  to  vessels  coming 
from  the  Republic  of  Venezuela  on  account  of  the  epidemic  of  plague  that 
broke  out  in  the  Port  La  Guaira. 

By  decree  of  May  7,  1908,  the  quarantine  against  vessels  from  Havana,  where 
there  had  formerly  been  some  cases  of  yellow  fever,  was  abolished. 

By  decree  of  July  6th  of  the  same  year  vessels  from  Port-of-Spain,  Trinidad, 
on  account  of  the  bubonic  plague,  were  denied  entry  in  Port  Limon. 

By  decree  of  October  19th,  last,  the  quarantine  against  vessels  from  Vene- 
zuela was  abolished,  because  it  was  proven  by  official  reports  that  plague  had 
disappeared  from  that  Republic. 


134  FOURTH    INTERNATIONAL   SANITARY   CONFERENCE. 

Outside  of  these  Governmental  provisions,  the  Department  of  Police,  which 
has  the  supreme  control  of  public  health,  has  enacted  all  the  necessary  measures 
for  the  exact  fulfilment  of  the  said  Convention  of  Washington. 

III. 

REPORTS  IN  REGARD  TO  THE  SANITARY  CONDITION  OF  PORTS 
AND  PROPOSED  MEASURES  FOR  THE  IMPROVEMENT  OF  SAID 
CONDITIONS,  WITH  SPECIAL  REFERENCE  TO  THE  PRINCIPAL 
PORTS. 

A. — Port  of  Puntarenas. 

The  sanitary  condition  of  this  port  has  been  satisfactory  during  the  last  two 
years.     There  has  been  no  epidemic    nor  infection  of  serious  diseases. 

The  three  principal  diseases  were : 

First,  malaria,  of  which,  in  1908,  there  were  only  78  cases  in  some  unhealthy 
places  along  the  coast.  There  are  formed  in  winter  small  swamps  which  are 
propitious  for  the  propagation  of  mosquitoes. 

Second,  ankylostomiasis,  of  which  there  were  SO  cases  last  year,  the  majority 
of  the  patients  being  from  Esparta,  Miramar,  and  Minas  de  Abangares. 

Third,  tuberculosis,  of  which  there  were  21  cases  in  1908  and  12  in  the 
current  year ;  some  of  the  patients  came  from  the  Province  of  Guanacaste. 

Besides  this,  there  are  cases  of  dysentery,  malaria,  whooping-cough,  and 
isolated  cases  of  measles,  and  pernicious  fever. 

The  death  rate  is  lower  than  that  of  some  cities  situated  on  the  central 
plateau    (30.58  per  thousand  in  the   last  nine  years). 

Animal  parasites  of  the  digestive  apparatus  are  plentiful,  especially  the 
tricocefalus,  the  asearis  lombiscoides,  and  the  uncinario  duedonalis,  which  cause 
a  considerable  amount  of  cases  of  chronic  diarrhea  in  children. 

The  proportion  of  venereal  diseases  in  the  town  is  remarkable.  Syphilis  and 
gonococcic  urethritis  have  established  themselves  in  the  port  and  they  are  a  real 
scourge. 

For  the  service  of  hygiene  the  city  is  divided  into  four  districts.  The  cleaning 
of  streets,  houses,  parks,  and  public  places  is  made  regularly.  The  personnel 
engaged  in  these  duties  is  sufficient  and  leaves  nothing  to  be  desired. 

Vaccination  is  made  at  fixed  periods  and  by  series  of  200  to  300  individuals. 

The  health  service  is  always  rigid,  especially  when  there  is  information  in 
regard  to  the  appearance  of  epidemic  in  the  northern  and  southern  ports. 

There  is  not  an  adequate  building  for  a  lazaretto.  For  yellow  fever  cases 
there  is  a  well-equipped  pavilion  which  has  not  yet  been  used,  because  there 
have  been  no  cases  as  yet.  There  is  no  pavilion  for  the  isolation  of  con- 
sumptives. 

The  disinfection  of  merchandise,  baggage,  and  rooms  is  made  with  a  Clayton 
apparatus,  using  sulphur  steam. 

The  water  consumed  in  Puntarenas  comes  from  natural  filtrations,  and  is 
extracted  by  means  of  suction  pumps,  duly  distributed  throughout  the  streets  of 
the  city. 

The  plans  for  the  water  supply  system  are  completed ;  the  supply  will  be 
taken  from  the  springs  of  the  Naranjo  River,  under  conditions  very  favorable 
for  the  health  of  the  city. 

There  are  no  sewers.     An  active  campaign  is  carried  on  against  mosquitoes. 

The  above  is  all  that  there  is  to  be  reported  in  regard  to  this  port. 

B. — Port  of  Limon. 

The  population  of  this  port  is  over  8,000;  the  majority  of  the  inhabitants  is 
composed  of  Jamaica  negroes,  tramp  laborers  from  the  West  Indies,  and  men 
from  the  coasts  of  Nicaragua,  Colombia,  and  Panama;  there  are  more  men 
than  women. 

The  soil  is  formed  on  an  irregular  plane,  the  highest  point  of  which  is  9  feet 
over  the  sea  level.  The  inhabited  portion  of  the  town  measures  a  longitude  of 
3.150  meters  by  1,900  meters  wide.  In  a  small  section  of  the  city  the  ground  was 
imperfectly  filled  in  with  refuse  and  garbage,  without  being  previously  drained. 
In  some  places  the  rain  water  stops  at  a  depth  of  one  foot  on  account  of  imper- 


FOURTH   INTERNATIONAL  SANITARY  CONFERENCE.  135 

meability  of  the  sub-soil.  Organic  decompositions  are  active;  the  phenomena  of 
oxidation,  on  the  contrary,  are  reduced  to  a  minimum.  The  improvement  of  this 
part  of  Limon,  by  means  of  filling,  drainage  and  canalization  is  imperative. 

The  sanitation  and  embellishment  of  the  city  have  greatly  improved  since 
the  widening  of  the  northern  part  thereof;  the  new  borough,  which  has  a 
splendid  topographic  position,  is  already  under  construction. 

The  city  is  comprised  in  the  isothermic  tropical  line,  within  the  zone  of  the 
trade  winds,  and  under  the  influence  of  the  cloud-ring.  Its  climate  is  torrid, 
and  its  mean  temperature  is  25.44°,  with  differences  oscillating  between  3  and  4 
degrees.  In  some  years  it  rains  for  275  days;  there  are  seasons  lasting  two  or 
three  months,  in  which  the  rains  are  continuous.     There  is  much  dampness. 

Formerly,  drinking  water  was  collected  by  means  of  main  pipes  along  the 
Banano  River,  at  seven  and  a  half  miles  from  the  city.  Recently,  repairs  were 
made  in  the  supply  tanks  and  in  the  pipes,  and  there  is  now  plenty  of  good 
water  for  the  needs  of  the  town. 

There  are  in  the  city  five  hundred  blocks,  approximately ;  nearly  four  hundred 
of  them  have  buildings ;  these  are  not  in  proportion  to  the  number  of  inhabit- 
ants, the  result  being  that  there  is  excessive  conglomeration  of  people  in  rooms 
and  barracks  to  the  detriment  of  hygiene.  In  view  thereof,  regulations  on  build- 
ings have  been  enacted,  the  purpose  of  which  is  to  remedy  such  conglomeration 
of  rooms  in  lots  in  order  to  get  as  much  revenue  as  possible  from  the  land, 
and  to  prevent  the  overcrowding  of  those  rooms,  as  is  now  done,  either  on 
account  of  the  scarcity  of  houses  or  for  the  sake  of  economy,  rent  being 
very  high. 

The  sewer  system  of  Limon  was  built  in  rather  unsatisfactorj'  conditions. 
The  bed  of  the  ejecting  canals  is  level  and  its  declivity  slight;  besides,  there 
was  not  sufficient  pressure  of  water  to  effect  the  clearing  of  the  sewers.  Now 
the  communicating  line  of  sewers  has  been  completed  with  vitrified  earthen 
pipes;  the  whole  town  can  deject  in  privies  and  dispose  of  the  liquid  refuse 
through  the  sewers.  In  the  whole  town  there  remain  only  46  well-privies,  which 
will  soon  be  filled  in,  and  then  the  town  will  be  entirely  free  from  the  infections 
that  they  spread. 

The  cleaning  service  of  the  city  is  perfect;  transportation  of  garbage  or 
refuse  by  means  of  wagons  of  the  Columbia  model;  daily  sweeping  of  the 
streets  by  squads  of  peons;  cleaning  of  pipes  and  privies  with  copper  sulphate; 
constant  general  inspection  of  houses,  yards,  and  sites;  disinfection  of  rooms 
with  irrigation  of  Kreso,  and  of  ponds,  swamps,  marshes  with  crude  petroleum 
in  large  quantities.  Violations  are  penalized  with  a  fine  of  from  1  to  25  colones. 
The  establishment  of  a  crematory  is  indispensable,  in  order  to  suppress  infec- 
tious foci  located  in  the  dumping  place  on  the  muddy  shores  of  the.  creek 
at  the  outlet  of  the  Limon  River,  very  near  the  city. 

The  sale  of  food  products  and  beverages  is  almost  monopolized  by  the 
Chinese.  The  majority  of  the  articles  of  food  are  imported  (preserved  meats, 
canned  or  barrelled  fish,  condensed  milk,  lard,  dried  codfish,  etc.),  and  the 
amount  of  adulterated  and  decomposed  products  that  are  seized  is  incalculable. 
The  ingestion  of  these  articles  produces  very  frequently  digestive  disturbances 
which  assume  the  nature  of  real  intoxication ;  ptomaine  poison  adopts  very 
acute  special  forms,  including  gastro-hepatic  and  septic-intestinal  disturb- 
ances, and  cholibacilosis  in  children.  It  is  imperative  that  there  should  be 
established  a  laboratory  for  the  analysis  for  the  food  products,  beverages,  and 
articles  of  consumption. 

The  campaign  against  the  mosquito  is  most  active  in  Limon ;  the  physician 
of  the  city,  Doctor  Cespedes,  is  an  indefatigable  champion  of  hygiene,  and  an 
officer  of  great  zeal;  the  sanitation  of  our  ports  and  the  Atlantic  region  is 
due  in  a  great  measure  to  his  efforts.  Doctor  Cespedes  recommends,  with  a 
radicalism  that  does  him  honor,  that  in  no  town  where  there  is  good  and  abun- 
dant water  the  existence  of  barrels,  tanks,  nor  any  other  kind  of  water  recep- 
tacle, whether  it  be  covered  or  uncovered,  should  be  consented  to.  He 
also  advises  the  suppression  of  canals  in  the  roofs  of  houses,  because  they  are 
simply  breeding  places  of  mosquitoes,  which  seek  refuge  therein  ;  or  in  privies 
full  of  water,  ponds,  and  holes  of  trees,  when  they  are  expelled  from  other 
places.  The  procedure  used  in  Limon  for  the  extermination  of  mosquitoes  has 
been  that  of  fumigating  sulphur  with  the  Clayton  apparatus,  which,  according 
to  Doctor  Cespedes,  gives  brilliant  results.  The  fumigation  with  camphorated 
fenol  has  hardly  any  effect  on  mosquitoes.     In  rooms  they  employ  sulphur  burnt 


136  FOURTH    INTERXATIONAL   SANITARY    CONFERENCE. 

in  caldrons,  in  a  proportion  of  two  pounds  per  1,000  cubic  feet.  The  stegotnya 
calopus  prevails,  and  the  anopheles  albipes  holds  second  place. 

The  plan  for  protection  on  land  against  the  yellow  fever  has  consisted  lately 
of  keeping  a  census  of  the  non-immune;  inspection  of  places  where  it  is  located; 
the  maintenance  of  a  constant  surveillance  over  non-immune  patients,  who  are 
isolated  in  the  hospital  immediately  after  the  appearance  of  the  first  symptoms 
of  continuous  fever.  Persons  taken  sick  in  hotels,  inns,  or  lodging  houses 
must  be  reported  to  the  health  authorities  by  the  owners  of  such  establish- 
ments, under  penalty  of  fine.  The  principal  object  in  view  is,  however,  the 
•greatest  possible  destruction  of  breeding  places  of  stegomya. 

There  are  other  problems  of  great  importance  to  the  health  of  Limon,  such 
as  the  excessive  death  rate  in  children,  malaria,  ankylostomiasis,  and  tuber- 
<:ulosis. 

Malaria  does  great  havoc  in  towns  and  in  the  fields.  Seventy  per  cent  of  the 
patients  are  hematozoic.  One-third  of  the  mortality  in  Limon  occurs  among 
■children,  especially  among  the  colored  ones. 

The  number  of  patients  and  deaths  of  tuberculosis  increases  every  year,  and  if 
it  is  not  duly  fought  it  will  soon  reach  the  rate  of  malaria  (35  during  the  last 
ten  months.) 

Fifty  per  cent  of  the  patients  treated  in  the  hospitals  show  in  their  feces 
•different  evolutive  formations  of  the  ankylostomiasis  parasite. 

Limon  requires  strict  surveillance  in  the  inspection  and  registration  of  vessels, 
and  the  maritime  hygiene  is  thus  effected.  The  port  is  in  constant  communica- 
tion with  those  on  the  Caribbean  Sea,  Colon,  Cartagena,  Puerto  Cabello, 
Sabanilla,  La  Guaira,  Havana,  Puerto  Cortes,  Puerto  Barrios,  etc.;  no  less 
than  six  hundred  vessels  enter  this  port  every  year,  and  its  general  traffic 
increases  very  rapidly. 

The  quarantine  service  in  Limon  should  be  improved  in  accordance  with  the 
resolutions  passed  by  previous  Sanitary  Conferences. 

We  beg  to  submit  with  this  report  special  annexes  in  regard  to  projects  for 
a  quarantine  station  in  Uvita  Island,  and  to  the  sanitation  of  Limon  in  general. 

IV. 

DATA  IN  REGARD  TO  THE  REGISTRATION  OF  THE  MOVEMENT 
OF  POPULATION  AND  OF  THE  DEATH  RATE  IN  THE  COUNTRY. 
WITH  SPECIAL  REFERENCE  TO  PORTS  AND  CITIES. 

We  have  attached  to  the  present  report  several  statistical  tables  relating  to 
population  and  mortality,  with  the  details  prescribed  by  the  provisional  pro- 
gramme ;  and  we  have  extracted  some  figures  from  them,  animated  by  the 
desire  of  furnishing  the  most  complete  information  in  regard  to  this  interesting 
question. 

It  should  be  stated  beforehand,  that,  as  regards  demography,  we  lack,  on 
account  of  the  difficulties  due  to  a  poor  organization,  a  really  scientific  basis 
that  would  enable  us  to  obtain  exact  statistics  of  the  prevailing  diseases,  those 
causing  the  greatest  number  of  deaths  in  the  different  cities  of  the  Republic; 
this  is  due  to  the  fact  that  there  is  no  law  compelling  the  registration  of 
deaths  and  the  real  causes  thereof.  In  many  places  where  there  are  no 
physicians  the  diagnosis  is  made  by  quacks  who  only  make  mention  of  symp- 
toms, common  to  different  diseases;  this,  naturally,  causes  confusion  and  up- 
sets the  mortality  statistics. 

During  a  period  of  nine  years,  from  1901  to  1909,  the  general  average  of 
mortality  has  been  25.3  per  thousand  inhabitants ;  the  lowest  figure  belongs 
to  1904,  22.94  per  thousand;  and  the  highest,  to  1905,  27.78  per  thousand.  In 
the  three  following  years  the  death  rate  ranged  between  25.18  and  25.98;  and 
from  January  1st  to'  September  30th  of  the  present  year — basing  the  estimate 
upon  population  of  361,779  inhabitants,  fixed  for  December  31,  1908,  with  a 
possible  increase  of  33^  per  cent — the  average  mortality  was  24.88  per  thousand. 
Therefore,  the  average  death  rate  in  1908  and  1909  is  25.44  per  thousand  in 
the  entire  Republic. 

The  number  of  births  registered  from  January  1,  1901,  to  September  30,  1909, 
was  of  114,348,  and  that  of  deaths  registered  during  the  same  period  was 
.73,179,  the  country  having  lost  in  1905  and  1909  more  than  9,000  inhabitants 
annually;  over  8,000  in  each  of  the  vears  1901,  1906,  and  1907;  over  7,000 
annually  in  1902,  1903,  and  1904;  and  6,753  during  the  present  year. 


FOURTH  INTERNATIONAL  SANITARY  CONFERENCE.  137 

In  regard  to  births,  we  have  to  state  that  the  statistics  include  only  those  that 
appear  in  the  auxiliary  civil  registers,  and  that,  in  fact,  the  figures  are  not 
absolutely  correct,  because  not  all  parents  comply  with  the  duty  of  registering 
the  births  of  their  children,  as  the  law  ordains. 

Specifying  these  statistics,  we  see  that,  during  the  said  period  of  nine  yea.rs, 
the  death  rate  is  distributed  among  the  Provinces  of  the  Republic  as  follows 
(statistics  of  1908)  : 

1.  Limon 42.48  per  1,000 

2.  Cartago 31.39 

3.  San   Jose    26.49 

4.  Puntarenas 26.48        " 

5.  Heredia 22.57 

6.  Alajuela 22.35 

7.  Guanacaste 19.97 

The  highest  death  rate  in  the  Republic  is  that  of  the  Port  of  Limen,  and  the 
lowest  that  of  the  City  of  Cartago,  12.62  per  thousand  in  the  first  nine  months 
of  the  present  year,  after  the  water-supply  system  had  been  improved  and  its 
perfect  sewer  system  had  been  opened  to  public  service. 

The  causes  of  mortality  in  the  country,  according  to  the  international  speci- 
fication  (Bertillon  system  of  14  groups),  was  in  1908  as  follows: 

Among  children  under  five  years  the  diseases  of  the  digestive  apparatus 
amount  to  1,857  deaths,  out  of  a  total  of  5,426,  of  which  682  belong  to  the 
Province  of  San  Jose,  and  426  to  that  of  Alajuela.  Undefined  diseases  were 
credited  with  1,232  deaths ;  diseases  of  the  nervous  system  or  of  the  organs 
of  sense,  1,813;  general  diseases,  709;  diseases  of  the  respiratory  apparatus,  452. 
Among  persons  over  five  years,  out  pf  a  total  of  3,698  deaths,  1,326  were  of 
general  diseases;  610  of  undefined;  597  of  the  digestive  apparatus,  and  307 
of  the  respiratory  apparatus.  The  highest  figures  always  belong  to  the  Prov- 
inces of  San  Jose  and  Alajuela. 
Infantile  mortality  is  distributed  as  follows: 

San    Jose 1,681 

Alajuela 1,073 

Cartago 1,065 

Heredia 481 

Guanacaste  293 

Puntarenas   204 

Limon  200 

Total 4,997 

Of  this  total  the  greatest  proportion  is  among  children  between  one  and  two 
years  of  age,  of  which  1,212  died.     Of  children  under  one  month,  991  died. 


The  mortality  statistics,  according  to  the  international  classification,  as  well 
as  the  infantile,  for  the  present  year,  are  still  in  course  of  preparation,  for 
which  reason  we  are  unable  to  include  them  here. 

Nevertheless,  reverting  to  the  special  causes  of  mortality,  recorded  in  the 
registers  of  the  General  Bureau  statistics,  we  will  make  a  sketch  of  the  condi- 
tions of  the  country  in  regard  to  the  commonest  of  those  diseases,  confining 
ourselves  to  the  period  elapsed  between  January  1,  1908,  and  October  31,  1909. 

These  statistics  are  classified  as  follows,  with  reference  to  the  entire  Republic 
(estimated  upon  a  population  of  nearly  400,000  inhabitants)  : 

1908      1909  Total 

Pulmonary   tuberculosis    357        252        609 

Tvphoid   fever    78  72        150 

Dysentery 375        323        698 

Whooping  cough    137        152        289 

Measles 232  22        254 

Malaria 189        139        328 

Infantile   cholera    376        351        727 

Intestinal    parasites    677        620     1,297 

Infantile    epilepsy    488        427        915 

Cancerous  diseases    154        108        262 


138  FOURTH    INTERNATIONAL   SANITARY    CONFERENCE. 

In  the  figures  for  convulsion  of  children,  abstract  average  used  by  the  Bureau 
for  statistics  and  based  by  necessity  upon  certificates  of  death  issued  by  quacks, 
the  following  diseases,  which  present  convulsions  as  a  characteristic  sign,  may 
be  understood  as  including:  tubercular  meningitis,  typhoid  fever,  intestinal  para- 
sites, and  eclampsia. 

In  accordance  with  the  preceding  table  the  category  of  typical  Costa  Rican 
diseases,  by  reason  of  mortality,  is  as  follows : 

I.  Intestinal  parasites.  VI.  Malaria. 

II.  Infantile  epilepsy.  VII.  Whooping  cough. 

III.  Infantile  cholera.  VIII.  Cancerous  diseases. 

IV.  Dysentery.  IX.  Measles. 

V.  Pulmonary  tuberculosis.  X.  Typhoid   fever. 

Intestinal  parasites  cause  in  our  country  two  deaths  per  day;  dysentery  kills 
one  person  every  day. 

But  what  really  causes  horror  is  the  mortality  in  children.  Fourteen  children 
die  each  day,  that  is  to  say,  one  every  two  hours ;  or  5,000  per  year,  on  account 
of  the  ignorance  of  the  quack,  the  poor  quality  of  water  in  small  towns,  poor 
food,  and  the  carelessness  in  properly  attiring  the  children. 

Dr.  Benjamin  de  Cespedes  published  not  long  ago  a  book  on  the  hygiene  of 
children  in  Costa  Rica,  which  was  awarded  a  prize  in  a  scientific  competition 
by  our  Faculty  of  Medicine  and  Surgery. 

Unfortunately,  the  lessons  contained  in  that  book  have  not  been  grasped  by 
the  people,  notwithstanding  the  fact  that  its  language  is  simple  and  easily 
understood;  it  seems  that  it  is  doomed  to  oblivion. 

Infantile  mortality  is  the  gravest  of  problems  that  the  country  has  to  con- 
front; and  the  efforts  exerted  for  the  protection  of  children  in  our  soil,  how- 
ever great  they  may  be,  will  never  reach  the  magnitude  required  by  this 
constant  and  awe-inspiring  danger  of  infantile  mortality,  which,  hour  after 
hour,  snatches  away  from  the  country  precious  energies,  incessantly  shattering 
to  pieces  our  hopes  for  the  future. 

Another  paper  bearing  directly  on  this  subject,  and  generally  on  the  highest 
interests  of  public  hygiene,  is  that  published  by  Dr.  Gerardo  Jimenez  and 
Engineer  Dr.  Enrique  Jimenez  Nunez,  entitled  "Hygiene  of  Houses  and  of 
Water  in  Costa  Rica."  This  work  was  awarded  a  prize  in  a  competition  given 
by  the  same  faculty  of  medicine,  and  it  is  destined  to  render  useful  service 
in  the  cause  of  public  health,  when  the  principles  that  it  contains  are  put  into 
practice. 

In  1908  there  were  429  still-births. 

There  are  two  diseases  of  which  we  have  no  knowledge  in  Costa  Rica,  to  wit : 
Rabies  and  hydatic  cysts  of  the  liver.  As  both  of  them  are  caused  by  the  bite 
or  toxic  secretions  of  dogs,  it  would  be  wise  to  prohibit  the  introduction  of 
foreign  dogs  or  to  submit  them  to  a  rigorous  quarantine  before  being  admitted 
into  the  country. 

There  are  isolated  cases  of  diphtheria,  the  death  rate  of  which  is  reduced  to  a 
minimum,  thanks  to  the  efficacy  of  the  anti-diphtheric  serum  generally  used. 
During  the  first  ten  months  of  the  present  year  only  three  mortal  cases  were 
reported. 

V. — Sanitation  of  Cities  and  Specially  of  Ports. 

Although  the  program  confines  this  subject  to  the  sanitation  of  cities  and 
ports,  we  have  deemed  it  wise  to  oflfer  to  the  Conference  a  few  details  regarding 
the  general  health  of  the  country,  so  that  the  delegates  may  have  an  idea  of  the 
hygienic  condition  of  Costa  Rica  from  every  point  of  view. 

The  climate  of  our  country  is  mild  and  healthful ;  the  mean  temperature 
varies  from  23°  to  26°  centigrade  during  the  normal  course  of  theyear;  this 
temperature  descends  in  the  months  from  November  to  March,  which  are  the 
most  brilliant  season  of  nature,  and  during  which  the  crops  of  cofifee  and 
other  grains  are  gathered.  It  should  be  stated,  however,  that  in  no  time  do 
we  experience  too  much  cold  nor  too  much  heat,  and  that  the  rainy  season 
extends  from  the  month  of  May  to  the  month  of  November  in  the  central 
regions  and  in  the  Pacific  zone,  with  some  variation  on  the  Caribbean  coast. 

As  a  matter  of  fact,  ravaging  epidemics  are  not  the  rule  in  our  country. 
The    day   shall   come    when   we   shall   be   totally   free    from   calamities    of   this 


FOURTH  INTERNATIONAL  SANITARY  CONFERENCE.  139 

sort,  and  it  is  our  supreme  duty  to  impress  hygienic  habits  upon  the  people, 
and  to  found  the  absolute  prominence  of  hygienic  science  upon  a  solid  basis, 
in  order  to  co-operate  with  nature,  which  affords  us  all  the  resources  of  life 
and  the  most  ample  facilities  in  the  struggle  therefor,  in  climatic  advantages, 
in  the  fertility  of  our  soil,  and  in  the  spirit  of  peace  and  labor  which  is  char- 
acteristic of  our  inhabitants. 

We  must  improve  our  sanitary  conditions  in  order  to  make  of  Costa  Rica  a 
center  for  tourists,  and  a  small  tropical  paradise.  In  this  particular  we  will 
take  the  liberty  to  make  a  brief  historical  interview  for  the  sake  of  argument. 

Many  years  ago  the  country  was  invaded  by  terrible  diseases,  such  as  leprosy, 
smallpox,  cholera,  and  yellow  fever. 

Leprosy  was  imported  into  the  country  about  the  middle  of  the  eighteenth 
century,  and  it  was  actively  fought  by  Governor  Tomas  de  Acosta,  one  of  our 
greatest  benefactors.  With  very  few  exceptions,  the  lepers  of  the  country  are 
confined  in  the  "Las  Mercedes"  Asylum,  and  it  can  be  said  that  this  disease 
does  not  constitute  a  public  danger,  thanks  to  the  activity  displayed  in  isolating 
persons  infected  therewith.  Smallpox  caused  enormous  ravages  during  the 
colonial  period.  Vaccine  was  first  introduced  into  our  country  in  1805,  and 
we  kept  ourselves  free  from  this  epidemic  scourge  until  1831,  when  there 
occurred  a  small  epidemic;  this  was  followed  by  the  ones  of  1845  and  1852  in 
which  the  disease  assumed  alarming  proportions,  a  fact  that  shows  a  relaxed 
activity  in  periodical  vaccination.  From  the  latter  date  on  we  have  only  had 
small  invasions,  the  last  taking  place  in  1891 ;  and  we  can  say  that,  during  the 
last  twenty  years,  smallpox  has  not  caused  any  loss  of  lives  in  the  country, 
and  that  we  need  not  fear  unexpected  contamination  because  vaccination  is 
carried  on  constantly;  so  much  so  that  Costa  Rica  may  be  considered  as  one 
of  the  countries  where  vaccination  is  general.  We  have  never  had  in  the  country 
any  anti-vaccination  league ;  vaccination  is  compulsory,  and  is  effected  without 
any  resistance  on  the  part  of  the  people,  who,  we  can  affirm,  appreciate  and 
accept  this  important  discovery. 

Cholera  holds  a  prominent  place  among  the  old  agencies  of  mortality  in  the 
Republic.  The  European  epidemic  of  1832,  which  reached  the  United  States, 
Mexico,  and  Martinique,  as  was  stated  at  that  time  in  our  official  documents, 
was  the  reason  for  the  initiation  of  an  energetic  campaign,  due  to  which  the 
country  kept  itself  free  from  infection ;  the  epidemic  of  1837  that  ravaged 
Nicaragua  gave  rise  to  the  establishment  of  a  sanitary  cordon  by  means  of 
which  we  were  able  to  prevent  its  introduction  into  our  country;  but,  on 
account  of  the  Central-American  wars  of  1856,  which  took  place  in  the  neigh- 
boring Republic,  and  in  which  our  army  participated,  an  epidemic  of  cholera, 
prevailing  in  some  town  of  that  country,  spread  rapidly  among  the  troops,  pre- 
cipitating the  return  of  our  soldiers,  who  brought  the  terrible  disease  into 
Costa  Rican  soil.  The  number  of  victims  was  over  10,000;  that  is  to  say,  one- 
fifteenth  of  the  total  population  then,  more  or  less,  but  this  fatal  contribution 
has  been  the  only  one  that  we  have  paid  to  that  dreaded  calamity.  The  Euro- 
pean epidemics  of  1865,  1884,  and  1890-1893  did  not  cause  us  any  damage,  thanks 
to  the  activity  of  the  public  authorities  in  putting  in  force  the  preventive 
measures  adopted  in  each  case. 

Yellow  fever  made  its  first  appearance  in  1853,  in  the  Port  of  Puntarenas. 
In  1860,  it  took  an  epidemic  character ;  the  same  was  the  case  in  1869,  but  with 
a  greater  damage.  The  next  epidemics  took  place  in  1881,  1892,  1895  and  1899; 
at  the  beginning  of  the  new  century  the  disease  became  endemic  and  gradually 
decreased  with  the  application  of  the  principles  and  methods  of  modern  prophy- 
laxis. Since  1903,  that  is  to  say,  six  years  ago,  yellow  fever,  we  can  affirm  with 
certainty,  does  not  exist  in  the  Pacific  littoral.  In  this  connection  it  is  our 
duty  to  pay  tribute  to  the  memory  of  Dr.  Manuel  Aguilar,  town  physician  of 
Puntarenas,  to  whose  efforts  are  due  in  a  great  measure  the  brilliant  success  of 
the  systematic  sanitation  of  that  port,  which  today  affords  public  health  the 
safest  guarantee. 

The  port  of  Limon  was  mercilessly  ravaged  by  yellow  fever  during  many 
years,  until  the  advancement,  the  sanitation  works,  the  drainage  of  the  swamps, 
the  sanitation  of  unhealthful  zones  and  the  wholesale  destruction  of  the 
Stegomya  Calopus  mosquito  gave  it  the  place  of  confidence  that  it  deserves  in 
the  roll  of  the  progress  of  the  country.  After  1903  only  five  cases  of  yellow 
fever  were  reported  in  different  places  of  the  Province  and  three  in  the  port  and 


140  FOURTH    INTERNATIONAL   SANITARY   CONFERENCE. 

city  of  Limon,  in  1906,  of  unknown  origin,  despite  the  strict  surveillance  exercised 
by  the  health  authorities,  among  whom  mention  should  be  made  of  Dr.  Benja- 
min de  Cespedes,  the  town  physician,  who  has  been  an  indefatigable  laborer  of 
hygiene  in  the  Atlantic  region.  Finally,  in  August.  1907,  there  were  two  sporadic 
cases  of  the  disease  in  the  Province,  the  first  of  which  was  imported  by  an 
Italian  immigrant ;  since  then  no  new  cases  have  been  reported. 

Elsewhere  in  this  report  we  dwell  at  length  upon  the  sanitary  condition  of 
our  two  principal  ports ;  and  before  closing  this  paragraph,  we  believe  it 
opportune  to  state,  with  regard  to  yellow  fever,  that  in  1899  an  epidemic  took 
place  in  the  city  of  Alajuela,  1,000  meters  above  the  level  of  the  sea,  receiving 
the  infection  from  Puntarenas;  of  over  one  hundred  patients  no  less  than 
one-third  died,  and  the  Government  spent  72,000  colones  to  fight  the  epidemic. 

Other  diseases  have  held  a  place  of  preference  in  the  annals  of  our  mortality, 
such  as  infectious  fevers ;  generalized  and  multiform  malaria ;  dysentery,  due 
to  the  poor  quality  of  water ;  whooping  cough,  which  appeared  about  the  begin- 
ning of  the  last  century ;  scarlet  fever,  which  dates  from  1865 ;  tj^phoid  fever ; 
endemic  influenza,  and  diphtheria,  which,  since  the  introduction  of  antitoxic 
serum,  produces  very  few  deaths,  and  these  are  due  to  the  lack  of  opportune 
medical  assistance. 

As  the  sphere  of  action  of  hygiene  is  widened  by  general  education,  sanitary 
propaganda  and  stringent  health  measures,  the  aforementioned  diseases  decrease 
rapidly  in  the  different  towns  of  the  country. 

The  previous  administrations,  and  the  present  one  especially,  have  always 
interested  themselves  in  the  problem  of  our  hygiene.  On  the  other  hand,  the 
party  that  won  the  last  elections  has  pledged  its  support  to  the  work  inspired 
by  these  Conferences,  according  to  Article  XX  of  its  political  programme, 
which  says :  "In  the  interests  of  public  health  to  appoint  town  physicians 
wherever  necessary ;  *  *  *  to  combat  mortality  in  an  efficient  manner ;  to 
encourage  and  support  popular  conferences  on  hygiene,  and  the  publication  of 
pamphlets  and  circulars  dealing  with  the  same  subject  and  distributed  gratis; 
and  to  prepare  and  publish  a  Costa-Rican  Sanitary  Code." 

The  President  of  the  Republic,  Senor  Cleto  Gonzalez  Viquez,  made  the  fol- 
lowing statement  in  his  inaugural  speech  of  May  8,  1906 : 

"Not  only  shall  the  Government  interest  itself  in  moral  hygiene,  but  it  shall, 
also,  with  the  same  eagerness  and  energy,  see  to  it  that  the  public  health 
and  the  hygiene  of  towns  and  settlements  are  carefully  looked  after.  It  is 
true  that  so  vital  a  duty  should  mostly  fall  on  the  municipalities,  but,  as  a 
general  rule,  they  lack  the  indispensable  material  means  for  the  realization 
of  the  water,  sewer,  disinfection  and  other  works  of  a  similar  nature.  The 
Government  is  ready  to  render  those  corporations  all  the  help  within  its  power. 
A  neglected  hygiene  injures  the  whole  country  in  an  incalculable  manner. 
Its  immediate  consequence  must  necessarily  be  decrease  in  population  and 
diminution  of  wealth." 

In  pursuance  of  these  ideas,  works  of  extreme  usefulness  have  been  realized 
in  the  country  under  the  auspices  of  the  present  political  regime,  and  it  is  just 
to  take  them  into  consideration  on  account  of  the  progress  that  they  have  secured 
for  our  public  health. 

In  the  first  place,  the  new  water  and  sewer  works  of  this  capital  have  always 
received  the  constant  attention  of  the  Government,  and  on  the  6th  of  October 
last  a  contract  for  the  construction  thereof  was  entered  into  between  the  sani- 
tation board  of  San  Jose,  in  behalf  of  the  municipality  and  a  national  company, 
and  approved  on  the  19th  of  November  last  by  the  Executive  Power;  this 
contract,  which  has  already  been  carried  out,  provides  for  the  utilization  of 
five  springs  of  excellent  water,  and  its  transportation  to  the  city  by  means 
of  cast-iron,  vitrified  clay  or  cement  tubes ;  the  distribution  of  the  water  in 
the  pipe  system,  which  will  have  to  be  improved  for  the  purpose ;  the  construc- 
tion of  a  complete  sewer  system  Mnth  three  purifying  plants  and  the  respective 
discharge  outlets.  The  principal  sewers  will  be  28,500  meters  in  length  and 
will  have  410  inspection  chambers,  100  washing  chambers  and  connections, 
and  10,970  meters  of  secondary  pipes  for  the  connection  of  house  sewers.  The 
percolating  filters  will  be  6,200 '  square  meters  at  least.  The  waterworks 
must  be  completed  on  July  31,  1912,  and  their  total  value  is  520,000  dollars. 

Within  two  years,  when  the  capital  will  be  provided  with  excellent  drinking 
water  and  good  sewers,  it  shall  be  free  from  the  infections  due  to  their  deficiency, 
and  many  of  the  calamities  afflicting  its   inhabitants  will  then   disappear  with 


FOURTH  INTERNATIONAL  SANITARY  CONFERENCE.  141 

the  consequent  decrease  in  the  death  rate,  as  has  been  the  case  in  other  cities 
under  similar  conditions.  According  to  the  statistical  estimate  made  by  Senor 
Gonzalez  Viquez,  in  1905,  the  death  rate  in  the  City  of  San  Jose  was,  in 
general,  35.78  per  1,000  inhabitants;  deducting  the  number  of  still-births  it  was 
33.22,  and  deducting  the  deaths  occurred  in  hospitals  among  persons  from 
abroad,  it  was  28.10  per  1,000.  These  figures,  at  the  end  of  ten  years  from 
their  date,  may  serve  as  a  basis  to  establish  the  necessary  dififerences  conse- 
quent to  the  improvement  of  the  water  system  and  the  construction  of  sewers; 
besides,  such  differences  will  be  in  the  future  a  convincing  argument  in  favor 
of  public  hygiene. 

The  second  work  to  which  we  refer  has  already  been  completed,  and  that  is 
the  construction  of  sewers  and  the  enlargement  of  the  water  system  in  the  city 
of  Cartago  by  virtue  of  a  municipal  contract,  approved  by  the  Executive  Power 
in  a  resolution  of  September  3,  1906.  This  work,  the  first  of  its  kind  perfectly 
completed  in  the  country,  cost  140,000  colones,  and  was  executed  within  eighteen 
months. 

A  resolution  of  January  8,  1907,  approved  the  contract  of  the  municipality 
of  Limon  for  the  construction  of  the  sewer  system  in  that  port,  according  to 
the  plans  of  Engineer  T.  H.  Barnes,  at  a  cost  of  157,000  colones,  and  within 
a  period  of  eighteen  months.  In  due  time  the  system  was  opened  to  the 
public  service. 

Before  the  present  administration  was  inaugurated  there  had  been  built 
ten  water-supply  systems,  of  which  five  were  provided  with  water  of  poor 
quality,  three  with  good  water,  one  with  fairly  good  water,  and  one  with 
excellent  water. 

In  the  construction  of  water  systems  they  only  had  in  mind  the  adduction  of 
the  liquid,  without  paying  any  attention  to  its  potable  condition,  nor  to  any 
other  requirements. 

In  the  new  waterworks,  built  since  May,  1906,  careful  attention  has  been 
given  to  hygiene,  sacrificing  many  times  the  quantity  to  the  good  quality  of 
the  water,  and,  above  all,  care  has  been  taken  to  ensure  the  possibility  of 
infection  of  the  water  and  its  purity. 

The  administration  of  President  Gonzalez  Viquez  is  accredited  with  the 
construction  of  23  water-supply  systems,  of  which  14  have  excellent  water, 
6  good  water,  and  3  inferior  water,  which  will  be  changed  as  soon  as  the 
waterworks  in  the  capital  shall  have  been  completed.  They  are  all  provided 
with  pipe  lines. 

Besides,  plans  and  specifications  have  been  prepared  for  seven  additional 
water-supply  systems. 

In  the  construction  of  waterworks  that  have  been  completed,  and  in  the 
preparation  of  plans,  special  care  has  been  taken  with  regard  to  the  physical 
condition  of  the  water  and  its  chemical  analj'sis ;  no  bacteriological  analysis 
was  done  on  account  of  the  lack  of  adequate  elements. 

Generally,  the  projects  make  provision  to  furnish  a  volume  of  250  liters  daily 
per  inhabitant,  for  twice  the  actual  population. 

In  our  judgment,  these  references  have  great  hygienic  importance  for  Costa 
Rica,  and  for  this  reason  we  make  mention  of  them. 

The  present  budget  contains  an  appropriation  of  151,043  colones  for  the 
expenses  of  public  hygiene,  in  charge  of  the  Department  of  Police.  Among 
those  expenses  are  the  salaries  of  town  physicians,  40  in  number,  each  having 
a  circuit  under  his  jurisdiction. 

As  often  as  necessary  the  Government  imports  at  its  own  expense  the  follow- 
ing serums :  antitetanic,  antipoisonous,  antitreptococcic,  antidiphtheric,  anti- 
plague,  vaccine,  antravoids  and  Slav  anticarbonous. 

Special  mention  should  be  made  in  this  chapter  of  the  Liquor  Law  in  force, 
enacted  with  the  purpose  of  restricting  the  use  of  alcoholic  beverages  and  of 
fighting  alcoholism,  a  vice  which  produces  so  many  moral  and  physiological 
damages  to  society. 

Quackery  is  actively  fought,  and  it  is  now  reduced  to  very  narrow  limits ; 
morphinism  is  also  energetically  opposed  and  punished  with  severe  penalties 
of  imprisonment  or  confinement  in  an  adequate  establishment;  the  public  streets 
and  sewers  are  under  the  constant  surveillance  of  the  health  authorities,  who 
have  free  access  to  houses;  public  parks  and  gardens  are  methodically  built, 
and  all  industries  which  may  become  foci  of  infection  or  which  may  injure 
the  atmosphere  are  ordered  away  from  the  centers  of  population ;  in  cases  of 


142  FOURTH    INTERNATIONAL   SANITARY   CONFERENCE. 

contagious  diseases  the  houses  and  patients  are  absolutley  isolated;  the  author- 
ities supervise  the  sale  of  foodstuffs,  the  cleaning  of  towns,  the  removal  of 
organic  refuse;  medicines  are  distributed  among  the  poor;  prostitution  is 
regulated  for  the  purpose  of  preventing  the  propagation  of  venereal  diseases, 
while  the  special  law  of  venereal  prophj'laxis — the  work  of  Dr.  J.  J.  UUoa 
when  Minister  of  the  Interior  from  1894  to  1898 — is  again  put  in  force,  as  its 
operation  was  suspended  partially  on  account  of  lack  of  funds  necessary  for  the 
maintenance  of  the  prophylaxis  service  required  by  said  law. 

The  courses  of  public  instruction  include  the  teaching  of  the  practical  prin- 
ciples of  hygiene,  and,  considering  the  wide  range  of  education  in  the  country, 
it  is  to  be  hoped  that  the  new  generation  will  be  fully  equipped  to  undertake 
the  redeeming  work  of  sanitation  in  all  its  aspcts,  conscientiously  and  without 
discouragement.  Costa  Rica  invests  to-day  in  the  Department  of  Public  In- 
struction the  annual  sum  of  1,271,935.64  colones,  out  of  seven  million  of  its  total 
fiscal  expenses. 

We  live,  therefore,  under  the  promise  of  a  future  sanitary  welfare ;  and 
upon  ourselves  depends  the  realization  of  the  ideals  expressed  by  the  old  motto 
of  our  sisters,  in  the  coat  of  arms  of  our  rising  country :  "Libre  crezca,  y 
fecundo." 

During   1908  and   1909  the  Republic  has   been    free   from   serious   epidemics. 

During  the  fiscal  year  of  1907-08,  on  account  of  the  increase  of  ankylosto- 
miasis, the  Government  appointed  a  Medical  Commission  to  study  said  disease, 
to  visit  the  infected  districts  and  to  attend  the  patients. 

The  Commission,  composed  of  Doctors  Luis  P.  Jimenez  and  Federico 
Carlos  Alvarado,  treated  more  than  5,000  cases,  and  submitted  the  interesting 
report  hereto  annexed. 

At  the  same  time,  Doctor  Mauro  Fernandez  wrote  a  pamphlet  for  the 
scientific  popularization  of  the  causes  of  ankylostomiasis  and  manner  of  pre- 
venting infection ;  by  order  of  the  Government  that  paper  was  printed  and 
widely  distributed. 

It  being  directly  related  to  public  hygiene,  we  will  mention  the  appearance 
of  the  epizooty  called  carbuncle  or  antrax,  which  occurred  in  the  beginning  of 
last  year  in  the  southern  section  of  the  capital. 

In  order  to  fight  the  epidemic  proper  measures  were  enacted,  and  cattle  for 
consumption  was  thoroughly  inspected;  the  necessary  serum  for  the  cure  of 
the  disease  was  imported ;  a  special  veterinary  was  engaged  in  the  United 
States,  and  is  still  rendering  his  services  at  the  expense  of  the  Government, 
although  the  disease  has  gradually  disappeared.  A  pamphlet  on  the  description 
and  treatment  of  the  disease  was  distributed  by  order  of  the  Department  of 
Police. 

Below  we  will  enumerate,  by  order  of  importance,  the  diseases  that  prevailed 
in  the  country  during  the  last  year  and  the  current  one ;  this  data  may  be 
considered  as  having  unlimited  retrospective  action,  as  said  diseases  are  char- 
acteristic of  Costa  Rica,  and  they  shall  continue  to  be  so  long  as  no  energetic 
and  decisive  measures  are  taken  to  counteract  their  effects,  to  reduce  their 
sphere  of  action,  to  exterminate  the  different  causes  leading  to  them,  and  to  anni- 
hilate their  incalcidable  pathologic  power  by  means  of  systematic  hygienization. 

Diseases  of  the  digestive  apparatus;  intestinal  diseases  proper,  and  specially 
intestinal  parasites.  In  regard  to  these  diseases  we  will  say  that  Doctor  Carlos 
Pupo  found  in  one  single  sample  of  fecal  matter  eggs  of  tricocephalus,  ascarides, 
oxiuros,  ankylostomiasis,  tape-worm,  and  also  intestinal  balantides  and  worms. 
Drinking  water,  in  general,  contains  a  great  quantity  of  algae  and  amoeba. 
Intestinal  parasites  cause  an  enormous  mortality  in  children. 

Dysentery. — In  the  city  of  San  Jose  alone  there  were  more  than  300  cases 
from  May,  1907,  to  February,  1908;  and  a  similar  proportion  is  continuously 
noticed  in  the  rest  of  the  country  (700  during  the  last  two  years). 

Malaria. — This  disease  appears  under  all  its  known  forms,  throughout  the 
different  regions  of  the  country,  and  is  endemic  in  all  seasons  of  the  year. 

Measles. — Since  some  time  ago  small  epidemics  appear  every  year. 

Whooping  cough. — The  death  rate  caused  by  this  disease  is  excessive;  it 
persists  in  a  latent  form  and  travels  throughout  the  country  entirely  acquainted 
with  the  inhabitants,  who,  being  used  to  it,  no  longer  dread  it  as  they  did 
the  epidemic  of  1893. 

Tuberculosis. — Its  propagation  is  continuously  increasing;  its  attacks  are  sure 
and   its   activity   unceasing.     From    May,    1907,    to    February,    1908,   there   were 


FOURTH  INTERNATIONAL  SANITARY  CONFERENCE,  143 

in  the  capital  alone  255  cases  subjected  to  medical  treatment  and  46  certified 
deaths.  Tuberculosis  causes  in  Costa  Rica  one  victim  every  twenty-four  hours. 
In  case  of  death  the  rooms  are  disinfected  with  sulphurous  gas  and  formaline 
and  the  clothing  and  other  dangerous  articles  of  personal  use  are  cremated. 
Due  praise  should  be  made  of  the  action  of  the  sanitary  authorities  in  the  Canton 
of  Goicoechea,  San  Jose  Province,  who  placed  posters  with  preventive  and 
prophylactic  directions  in  the  parochial  church  of  the  town  of  Guadalupe ;  this 
example  should  be  unanimously  followed  in  the  rest  of  the  country.  As  an 
urgent  measure,  the  creation  of  a  sanatorium  for  consumptives  is  imperative. 
A  few  years  ago  an  antituberculosis  league  was  founded,  but  it  had  to  be 
closed  through  lack  of  spirit  of  appreciation  and  of  private  initiative,  and  it 
is  necessary  to  re-establish  the  same  under  the  auspices  of  the  Government. 

Influenza. — It  is  almost  epidemic,  especially  since  the  latter  part  of  1907.  It 
presents  a  great  number  of  broncho-pulmonar  complications. 

Ankylostomiasis. — We  have  already  referred  to  this  national  calamity,  which 
represents  an  enormous  loss  of  energy  in  the  country. 

Typhoid  fever. — In  Grecia  it  appeared  under  an  epidemic  form  in  the  latter 
part  of  1907,  and  it  subsided  in  consequence  of  the  construction  of  a  good 
water-supply  system  and  of  the  prophylactic  measures  that  were  adopted.  It 
ravages  the  whole  country  unceasingly,  but  it  is  noticeably  decreasing  with 
the  advance  of  hygiene. 

Varicella  and  Rubiola. — Local  and  almost  inoffensive  epidemics  which  have 
quickly  disappeared  and  offer  no  greater  difficulty. 

Syphilis  and  Venereal  Diseases. — A  retrocession  is  noticed  in  this  particular 
point  on  account  of  the  suspension  of  the  Law  of  Venereal  Prophylaxis,  the 
re-enactment  of  which  is  imperative,  and  which,  at  a  former  time,  gave  very 
satisfactory  results ;  the  census  statistics  show  very  rare  exceptions  of  indi- 
viduals who  have  not  suffered  from  some  disease  of  this  kind  before  being 
twenty  years  old. 

Mumps  or  Parotitis. — A  general  epidemic  in  the  last  two  years,  which  increases 
with  the  rapid  changes  of  temperature.  In  general,  it  has  been  of  a  mild 
character. 

Such  was,  briefly  told,  the  condition  of  public  health  in  Costa  Rica  during 
the  recess  of  the  International  Sanitary  Conference  of  the  American  Republics. 
With  the  centralization  of  the  Public  Health  Service  and  the  unification  of 
the  laws  relating  thereto,  by  means  of  a  national  board  of  health  and  of  a 
sanitary  code,  the  present  situation  would  be  improved  day  by  day. 

We  earnestly  hope  that  our  aspirations  in  the  matter  of  hygiene  will  be 
realized  in  the  very  near  future,  for  the  honor  and  glory  of  the  country  and 
for  the  immediate  benefit  of  humanity. 

We  dealt  with  the  sanitation  of  our  ports  when  we  spoke  of  the  sanitary 
conditions  prevailing  thereat.  We  have  nothing  to  add  in  this  special  chapter 
of  the  program. 

VI. — Charitable  Institutions — Hospitals  and  Asylums. 

Public  beneficence  in  Costa  Rica  is  duly  maintained. 

To  succor  the  sick;  to  shelter  poor  children  as  well  as  old  persons  who 
on  account  of  their  age  or  feebleness  are  not  in  a  position  to  work;  to  isolate 
those  who,  having  lost  their  mind,  constitute  a  public  menace,  or  those  who, 
still  more  unfortunate,  with  full  possession  of  their  minds,  witness  the  destruc- 
tion of  their  organism,  such  as  is  the  case  with  the  lepers,  outcasts  of  society 
whose  only  protection  is  the  Government;  in  a  word,  to  exercise  practically 
and  efficiently  the  noble  apostleship  of  human  charity,  have  always  been  in  this 
country  matters  which  have  received  careful  attention. 

In  the  realization  of  this  end  the  efforts  of  the  Republic  have  been  crowned 
with  success  to  such  an  extent  that  in  some  cases,  for  instance,  in  the  hospital 
for  mental  diseases,  the  Chapui  Asylum,  the  results  obtained  are  a  just  and 
legitimate  motive  for  national  pride. 

Of  course,  it  should  be  stated  that,  outside  of  the  two  charitable  institutions 
founded  by  the  Government — the  said  asylum  and  that  of  "Las  Mercedes,"  for 
lepers — all  the  other  charitable  institutions  of  Costa  Rica  owe  their  creation  and 
maintenance  to  private   initiative   exclusively. 

This  is  a  most  eloquent  fact  and  worthy  of  the  greatest  attention,  as  it  speaks 
very  highly  for  the  excellence  of  sentiments  characteristic  of  our  people,  and 


144  FOURTH    INTERNATIONAL   SANITARY   CONFERENCE. 

which  secures  for  the  country  a  place  of  honor  among  the  altruistic  communities 
of  the  earth. 

It  should,  likewise,  be  noticed  that  municipal  action  has  never  contributed 
to  the  foundation  of  an  asylum  or  hospital ;  at  most,  the  municipalitie*  hardly 
assist  in  the  maintenance  of  such  charitable  institutions. 

In  some  cases,  and  of  them  we  have  more  than  one  example,  philanthropic 
establishments,  founded  by  private  initiative  and  through  the  efforts  of  some 
great  social  benefactor,  find  themselves  without  sufficient  resources  to  meet 
their  necessities.  It  is  customary  in  such  events  for  the  Government  to  help, 
even  though  not  as  liberally  as  desirable,  at  least  with  the  promptness  and 
sufficiency  necessary  to  cover  the  deficiency. 

The  fiscal  budget  appropriates  the  sum  of  94,552  colones  for  charitable  pur- 
poses, and  besides  this  sum  other  expenses  of  this  kind  are  made  by  different 
departments,  and  special  laws  provide  for  the  lofty  aims  of  national  charity. 

It  is  the  public  spirit,  however,  that  carries  the  burden  of  the  work;  and  in 
doing  so  it  fulfills  spontaneously  the  Christian  ideals  which  are  the  inspiration 
of  its   actions. 

In  his  last  annual  message  to  Congress  the  President  of  the  Republic  said: 

"The  number  and  importance  of  charitable  establishments  being,  as  they  are, 
sufficiently  considerable,  it  would  be  advisable  to  take  under  consideration  the 
creation  of  a  Department  of  Public  Beneficence,  with  central,  provincial  and 
cantonal  bureaus,  under  adequate  regulations,  taking  advantage  for  that  purpose 
of  the  co-operation  of  charitable  societies  and  of  citizens  and  foreigners  who 
sympathize  with  the  suffering  masses." 

The  necessity  pointed  out  by  the  President  is  really  a  peremptory  one.  The 
boards  of  charity  operate  with  absolute  independence  throughout  the  country, 
but  if  their  services  were  regulated  an  immediate  profit  would  be  derived  from 
harmonizing  the  charitable  work  in  their  different  details,  thus  rendering  phil- 
anthropic protection  more  fruitful  and  uniform,  through  the  agency  of  an 
organic  center  having  supervision  over  all  charitable  enterprises,  to  the  benefit 
of  the  community  and  of  the  needy. 

There  are  four  asylums  in  the  country,  to  wit:  The  Chapui  Asylum, _  the 
Alms  House,  the  Leper  Asylum  and  the  Children's  Asylum.^  There  are,  besides, 
one  hospice  for  orphans  in  the  capital  and  two  in  the  city  of  Cartago;  and 
twelve  hospitals  in  San  Jose,  Cartago,  Alajuela,  Heredia,  Liberia,  Limon,  Pun- 
tarenas,  San  Ramon,  Grecia  and  Las  Canas. 

The  total  number  of  persons  attended  by  these  institutions  during  1908  was 
8,000,  at  a  total  expense  of  600,000  colones.  The  Hospital  of  San  Juan  de  Dios 
alone  attended  2,0(K)  individuals;  a  similar  number  was  treated  in  the  hospitals 
at  Limon. 

The  first  charitable  establishment  founded  in  the  country  was  the  lazaretto, 
in  1833,  whose  capital,  together  with  that  of  a  general  hospital  in  project,  was 
4,500  colones.  This  sum  was  made  up  of  municipal  and  private  voluntary  con- 
tributions. In  1885  the  lazaretto  was  definitely  built  in  the  neighborhood  of 
the  capital,  to  the  west,  and  near  the  Savana  de  Mata  Redonda. 

In  the  month  of  May,  1908,  the  lepers  lodged  in  the  lazaretto  were  removed 
to  the  new  Asylum  of  Las  Mercedes,  which  has  a  capacity  for  125  beds  and 
has  all  the  hygienic  requisites  needed  in  an  institute  of  this  kind. 

In  1845  a  project  was  made  for  the  foundation  of  a  general  hospital  of  the 
state,  to  be  supported  by  means  of  a  lottery;  but  the  scheme  failed  on  account 
of  the  unpopularity  of  the  means  sought.  It  was  only  in  1852  when  the  building 
for  the  Hospital  of  San  Juan  de  Dios  was  constructed,  but  it  had  to  be  closed 
in  1861  on  account  of  lack  of  funds.  On  May  8,  1863,  it  was  reopened,  and 
the  Sisterhood  of  Charity  was  organized,  just  as  it  now  stands;  the  institute 
was  placed  under  the  control  of  a  governing  board  which  drafted  the  charter 
and  regulations  that,  with  slight  amendments,  still  govern  it.  In  the  course 
of  its  existence  it  has  received  large  donations  and  legacies  from  private  per- 
sons ;  one  of  the  most  noticeable  which  was  that  given  by  Presbyter  Jose  Cecilio 
Umafia  whose  name  is  recorded  in  the  annals  of  the  national  beneficence.  In 
1872  important  improvements  were  made  in  the  building  of  the  mstitution 
and  its  interior  administration  was  entrusted  to  the  Sisters  _  of  Charity.  In 
1881  an  interne  physician  was  appointed  and  a  division  of  statistics  of  diseases 
was  created.  In  1888  the  hospital  was  divided  into  two  departments:  medicine 
and   surgery.    Besides  the  subsidies  that  it  receives  from  the  Government,  a 


FOURTH  INTERNATIONAL  SANITARY  CONFERENCE.  145 

percentage  of  the  sale  of  railroad  tickets  is  assigned  to  it.  The  provincial 
hospitals   are   also  given   a  similar  percentage. 

In  1852,  the  same  year  when  the  San  Juan  de  Dios  Hospital  was  founded, 
the  Hospital  of  San  Rafael,  in  Puntarenas,  was  established;  for  a  period  of 
28  consecutive  years  these  were  the  only  two  establishments  of  their  kind 
operating  in  the  Republic. 

In  1818  the  Hospitals  of  Cartago  and  Liberia  were  opened  to  the  public; 
in  1884,  those  of  Alajuela  and  Limon ;  in  1888,  that  of  Heredia;  in  1891,  those 
of  Grecia  and  Palmares,  the  first  villages  that  were  provided  with  hospitals; 
in  1895,  that  of  Santa  Cruz,  and  the  rest  in  latter  years. 

In  1885  the  Government  donated  the  sum  of  5,(XX)  colones  to  the  Board  of 
Charity  of  San  Jose  for  the  establishment  of  an  insane  asylum,  which  was 
made  a  national  institution ;  at  the  same  time  a  monthly  lottery  for  the  support 
of  this  institution  was  authorized. 

The  National  Hospital  for  the  Insane  was  inaugurated  on  May  4,  1890,  but 
its  name  was  changed  later  to  that  of  Chapui  asylum,  in  honor  of  Presbyter 
Chapui,  a  great  benefactor  of  our  country.  This  asylum,  during  the  first  ten 
years  of  its  existence,  attended  740  patients  with  really  remarkable  results. 
At  present  the  number  of  patients  is  about  300  annually.  The  hospice  for 
incurables,  now  called  Alms  House,  was  founded  in  1879  with  private  con- 
tributions. 

Such  is  in  brief  the  history  of  our  principal  charitable  institutions. 

In  closing  this  report  the  Delegation  of  Costa  Rica  expresses  its  recognition 
of  the  services  rendered  by  Sefior  Guillermo  Vargas  in  the  preparation  thereof. 

MORTAL  CASES  OF  DIFFERENT  DISEASES  IN  THE  CITIES  OF  THE 

REPUBLIC  FROM  JANUARY  1ST  TO  OCTOBER  31,  1909. 

San  Jose. 

Cancer 27  Diphtheria 2 

Dysentery 41  Malaria 3 

Tuberculosis 53  Bilious    fever 0 

Typhoid  fever   12  Blackwater    fever    1 

Influenza 0  Pernicious  fever  0 

Malaria 4  Remittent  fever  0 

Whooping-cough 4  Measles 0 

Alajuela. 

Cancer 5  Diphtheria 1 

Dysentery 11  Malaria 0 

Tuberculosis 8  Bilious  fever   0 

Typhoid  fever   6  Blackwater  fever    0 

Influenza 3  Pernicious  fever  0 

Malaria 2  Remittent  fever  0 

Whooping-cough 14  Measles 0 

San  Ramon. 

Cancer 1            Diphtheria 0 

Dysentery 4            Malaria 0 

Tuberculosis 1            Bilious  fever   0 

Typhoid  fever  1            Blackwater  fever   0 

Influenza 3            Pernicious  fever  0 

Malaria 1             Remittent   fever    0 

Whooping-cough 1            Measles 0 

Grecia. 

Cancer 1  Diphtheria 0 

Dysentery 7  Malaria 0 

Tuberculosis 2  Bilious  fever  1 

Typhoid  fever  0  Blackwater  fever   0 

Influenza 2  Pernicious  fever  0 

Malaria 0  Remittent  fever  0 

Whooping-cough 6  Measles 0 


146  FOURTH    INTERNATIONAL   SANITARY   CONFERENCE. 

Cartago. 

Cancer 2            Diphtheria 0 

Dysentery 3            Malaria 0 

Tuberculosis 2            Bilious  fever 0 

Typhoid  fever   1             Blackwater  fever   0 

Influenza 0            Pernicious  fever  0 

Malaria 1            Remittent  fever  0 

Whooping-cough 1            Measles 0 

Herkdia. 

Cancer 1             Diphtheria 0 

Dysentery 9            Malaria 0 

Tuberculosis 11             Bilious  fever    0 

Typhoid  fever  2            Blackwater  fever    0 

Influenza 2            Pernicious  fever  0 

Malaria 3            Remittent  fever  3 

Whooping-cough 2            Measles 0 

Santo  Domingo. 

Cancer 2            Diphtheria 0 

Dysentery 12            Malaria 0 

Tuberculosis 8            Bilious  fever    0 

Typhoid  fever  1             Blackwater  fever    0 

Influenza 1             Pernicious  fever  0 

Malaria 0            Remittent  fever  0 

Whooping-cough 1            Measles 0 

Liberia. 

Cancer 1            Diphtheria 0 

Dysentery 7            Malaria 0 

Tuberculosis 8            Bilious  fever    0 

Typhoid    fever    0            Blackwater  fever    0 

Influenza 1             Pernicious  fever  1 

Malaria 14            Remittent  fever  5 

Whooping-cough 0            Measles 0 

Puntarenas. 

Cancer 0            Diphtheria 0 

Dysentery 6            Malaria 1 

Tuberculosis 12            Bilious  fever    0 

Typhoid  fever  0            Blackwater  fever    0 

Influenza 0            Pernicious    fever    1 

Malaria 6            Remittent  fever  0 

Whooping-cough 3            Measles 1 

Esparta. 

Cancer 1            Diphtheria 0 

Dysentery 2            Malaria 0 

Tuberculosis 5            Bilious  fever   1 

Typhoid  fever  0            Blackwater  fever    0 

Influenza Q            Pernicious  fever  0 

Malaria 1            Remittent  fever  0 

Whooping-cough 1             Measles 4 

LiMON. 

Cancer 1             Diphtheria 0 

Dysentery 11             Malaria 12 

Tuberculosis   25            Bilious  fever   3 

Typhoid  fever  0            Blackwater  fever   2 

Influenza 0            Pernicious  fever  0 

Malaria ' 35            Remittent  fever  0 

Whooping-cough 0            Measles 0 

Note. — What  makes  the  death  rate  greater  are  the  diseases  of  children,  espe- 
cially intestinal  pasaites,  infantile  cholera  and  convulsions. 
National  Bureau  of  Statistics, 
San  Jose,  December  IS,   1909. 


FOURTH  INTERNATIONAL  SANITARY  CONFERENCE.  147 

SEVERAL   MORTAL   CAUSES   IN   THE   CITIES    OF   THE   REPUBLIC 
FROM  JANUARY  1ST  TO  OCTOBER  31,  1909. 

San  Jose. 

Enteritis 48  Parasites 40 

Convulsions 15  Infantile  cholera 28 

Bronchitis 14  Gastro-enteritis 46 

Broncho-pneumonia 16 

Alajuela  and  Districts  of  San  Jose,  Garita  and  Tuetal. 

Enteritis 6  Convulsions 6 

Parasites 24  Broncho-pneumonia 6 

Infantile  Cholera   18  Bronchitis 2 

Gastro-enteritis 5 

San  Ramon. 

Gastro-enteritis 1  Enteritis 1 

Parasites 7  Infantile  cholera 3 

Convulsions 1  Broncho-pneumonia 1 

Grecia. 

Parasites 8  Convulsions 2 

Infantile  cholera 7  Bronchitis 1 

Cartago. 

Parasites 4  Bronchitis 2 

Infantile  cholera 2  Broncho-pneumonia 1 

Enteritis 3 

Heredia. 

Gastro-enteritis 31  Broncho-pneumonia 7 

Bronchitis 4  Parasites 4 

Infantile  cholera 8  Convulsions 1 

Enteritis 12 

Santo  Domingo. 

Parasites 2            Enteritis 1 

Infantile  cholera 3            Bronchitis 2 

Gastro-enteritis 7            Broncho-pneumonia 3 

Convulsions 1 

Liberia. 
Bronchitis 1 

Puntarenas. 

Bronchitis 1  Convulsions 6 

Parasites 22  Gastro-enteritis 1 

Broncho-pneumonia 4  Enteritis 4 

Esparta. 
Parasites '. 5  Infantile  cholera I 


LiMOK. 

Gastro-enteritis 15  Infantile  cholera I 

Convulsions 1  Parasites l 

Enteritis 15  Bronchitis 5 

Broncho-pneumonia 3 

National  Bureau  of  Statistics, 
San  Jose,  December  21,  1909. 


148  FOURTH    INTERNATIONAL   SANITARY   CONFERENCE. 

SEVERAL  CAUSES  OF  MORTALITY,  BY  PROVINCES,  1908. 
Additional  Table. 


o 


^  o 

3  rt 


Diseases. 

Leprosy     2  0  1  0  0  0  0  3 

Influenza 20  45  24  7  3  4  3  106 

Diphtheria 00  00  00  00  1  00  00  1 

Scarlet  fever   00  1  00  36  0  00  00  1 

Bronchitis 85  51  104  20  2  12  9  299 

Bronco-pneumonia 73  8  19  34  4  1  6  131 

Enteritis 98  15  76  108  2  6  19  250 

Gastro-enteritis 105  25  19  00  00  4  8  269 

Pernicious  fever  2  00  00  1  1  4  8  15 

Remittent  fever  1  1  00  00  4  1  11  19 

Y^ellow  fever  1  00  00  00  00  00  1  2 

Blackwater  fever 2  5  1  00  00  00  3  11 

Malaria 1  00  00  00  00  00  20  21 


m 

Diseases. 

Cancer 52 

Dysentery 103 

Tuberculosis 88 

Typhoid  fever  41 

Influenza 12 

Malaria 17 

Whooping-cough 25 

Diphtheria 2 

Measles 5 

Malaria 8 

Blackwater  fever  1 

Yellow  fever  1 

Pernicious  fever  00 

Bilious  fever  00 

Remittent  fever 00 

Leprosy  2 

National  Bureau  of  Statistics, 

December  22,  1909. 

CONCENTRATION   BY    PROVINCES,   JANUARY   1ST   TO 
OCTOBER  31,  1909. 

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21 

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323 

26 

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33 

18 

30 

37 

252 

13 

9 

6 

2 

0 

1 

72 

23 

15 

10 

3 

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67 

14 

13 

6 

22 

12 

55 

139 

84 

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17 

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152 

1 

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C/3 


Diseases. 

Convulsion   of  children 130 

Bronchitis 75 

Broncho-pneumonia 25 

Parasites 227 

Infantile  cholera 142 

Gastro-enteritis 80 

Enteritis 93 


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130 

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47 

108 

37 

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280 

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23 

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80 

191 

64 

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620 

128 

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351 

11 

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207 

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247 

FOURTH  INTERNATIONAL  SANITARY  CONFERENCE.  149 

POPULATION  OF  THE  REPUBLIC— BIRTHS,  DEATHS,  AND  AVER- 
AGE PER  1,(XX)  FROM  1901  TO  1909. 


'i^ear. 

Population. 

Births. 

Deaths. 

Average  per 

1900 

307,499 

1901 

312,819 

ii,'387 

8,151 

26.57 

1902 

316,738 

11,078 

7,973 

25.48 

1903 

322,618 

11,613 

7,291 

23.01 

1904 

331,340 

12,547 

7,404 

22.94 

1905 

334,297 

12,594 

9,205 

27.78 

1906 

341,590 

13,443 

8,417 

25.18 

1907 

351,176 

14,762 

8,861 

25.94 

1908 

361,779 

15,308 

9,124 

25.98 

1909 

11,658 

6,753 

24.88 

National  Bureau  of  Statistics, 
San  Jose,  December  11,  1909. 

Notes. — A.  The  year  1909  comprises  only  nine  months,  that  is  to  say,  from 
January  1st  to  September  30th.  The  averages  per  thousand  have  been  estimated 
on  the  population  up  to  December  31st  of  the  previous  year,  and  for  1909  that 
average  was  increased  333^  per  cent  in  order  to  obtain  the  probable  rate  for 
the  whole  year. 

Under  the  heading  of  "Births"  only  those  inscribed  in  the  Auxiliary  Civil 
Registers  are  included  and,  therefore,  the  figures  are  very  low,  because  not  all 
the  parents  comply  with  the  duty  of  notifying  the  birth  of  their  children. 


FOURTH   INTERNATIONAL  SANITARY  CONFERENCE.  151 

REPORT  OF  DOCTOR  HUGO  ROBERTS,  DELEGATE 
FROM  CUBA. 

Mr.  President ;  Messrs.  Delegates :  In  pursuance  of  the  provisional  program 
of  the  present  Conference  I  have  the  honor  to  report  that,  since  the  Third  Con- 
ference, held  in  Mexico  in  December,  1907,  the  sanitary  laws  and  measures 
enacted  in  the  Republic  of  Cuba,  which  I  have  the  honor  to  represent,  now 
in  force,  are,  by  chronological  order,  the  following: 

On  October  20,  1908,  the  Provisional  Governor  of  Cuba,  Mr.  Charles  E.  Ma- 
goon,  issued  Decree  number  1024,  establishing  the  basis  for  the  drafting  of 
regulations  for  the  practice  of  pharmacy,  sale  of  drugs  and  medical  products,  the 
preparation  of  pharmaceutical  products  and  the  preparation  and  sale  of  serums 
and  substances  for  vaccination.  These  regulations  are  in  force  since  the  18th 
of  July  last,  and  have  taken  the  place  of  the  Ordinances  of  Pharmacy  which 
govern  the  practice  of  this  profession  since  1860;  they  have  come  to  fill  a 
necessity  which  was  really  felt,  placing  the  practice  of  pharmacy  in  Cuba  in 
accordance  with  the  progress  accomplished  in  that  line,  and  establishing  guaran- 
ties required  in  the  practice  of  a  profession  so  closely  connected  with  the  inter- 
ests of  public  health.  A  decree  was  also  promulgated  enforcing  the  United 
States  Pharmacopoeia,  8th  edition,  translated  into  Spanish. 

Since  January  28,  1908,  the  Law  of  the  Executive  Power  and  the  regulations 
for  the  management  of  the  Executive  Departments  has  also  been  enforced.  By 
virtue  of  that  law  a  Department  of  Health  and  Beneficence  has  been  created; 
this  branch  was  formerly  under  the  Department  of  the  Interior.  The  new  de- 
partment has  been  operating  since  that  date  with  the  most  flattering  of  successes. 
The  first  to  occupy  the  high  position  of  Secretary  of  Health  and  Beneficence 
was  Doctor  Matias  Duque  y  Perdomo,  and  after  his  resignation,  in  October  of 
this  year,  Doctor  Manuel  Varona  Suarez  was  appointed  to  succeed  him.  The 
Republic  of  Cuba  has  had  the  privilege  of  being  the  first  nation  in  organizing 
an  Executive  Department  of  Health  and  Beneficence,  an  example  which,  in  view 
of  the  good  results  that  will  be  obtained,  will  soon  be  followed  by  other  nations. 

On  July  1st  of  the  present  year  the  Legislature  passed  the  Civil  Service  law, 
to  establish  and  maintain  an  efficient  honest  Civil  Service  in  all  the  departments 
of  the  Central  Provincial  and  Municipal  Government  of  the  Republic,  which  law 
undoubtedly  is  very  essential  to  the  Health  Service,  leaving  it  free  from  political 
differences. 

There  has  been  organized  under  the  Department  of  Health  a  bureau  for 
the  investigation  and  study  of  infectious  diseases,  provided  with  a  naval  per- 
sonnel and  with  the  necessary  material  elements,  such  as  a  special  laboratory 
for  its  important  mission.  Its  work  will  be  published  in  "Health  and  Benefi- 
cence," the  official  bulletin  of  the  department,  the  publication  of  which  was 
commenced  last  April  and  which  constitutes  one  of  the  most  important  works 
of  the  new  department. 

By  presidential  decree  of  July  19th  last  the  cleaning  of  streets,  the  collection 
and  disposal  of  garbage,  and  the  disinfection  of  sewers  and  canals  of  the  city 
of  Havana,  which  were  under  the  Department  of  Public  Works,  have  been 
transferred  to  that  of  Health  and  Beneficence. 

In  the  Insane  Asylum  of  Mazorra  there  has  been  established  a  special  school 
for  nurses,  the  professors  of  which  are  nurses  who  have  been  expressly  engaged 
in  England.  In  connection  with  the  Tuberculosis  Dispensary  there  is  also  a 
school  for  nurses,  specialists  in  the  treatment  of  consumptives;  these  nurses  not 
only  are  on  duty  in  the  Dispensary,  but  also  visit  the  homes  of  poor  consump- 
tives; they  are  under  the  supervision  of  the  physicians  in  charge  of  the 
Dispensary. 

The  eradication  of  tuberculosis  is  one  of  the  principal  aims  of  the  new  de- 
partment ;  besides  the  Sanatorium  of  La  Esperanza,  established  at  a  proper  place 
within  ten  kilometers  from  Havana,  others  will  be  established  in  different 
places  of  the  Republic,  the  creation  of  which  is  under  consideration,  as  well 
as  other  measures  tending  to  diminish  the  ravages  of  tuberculosis,  preventing 
its  propagation. 

The  Municipality  of  Havana  has  recently  opened  the  Emergency  Hospital,  for 
the  immediate  attendance  of  wounds,  injuries,  accidents,  etc.,  before  the  patients 
are  taken  to  their  homes  or  to  some  other  hospital. 


152  FOURTH    INTERNATIONAL   SANITARY   CONFERENCE. 

There  is  under  the  Department  of  Health  a  Bureau  of  Sanitary  Engineering, 
with  jurisdiction  over  all  the  Republic. 

The  Department  of  Health  being  aware  of  the  great  benefit  that  might  be  de- 
rived from  instructing  the  people  in  regard  to  contagious  and  preventable  dis- 
eases, it  has  also  directed  its  attention  toward  that  end;  and  by  means  of  popu- 
lar pamphlets,  couched  in  simple  terms,  it  has  informed  the  people  as  to  what 
tuberculosis  is;  bow  the  infection  is  effected;  how  a  person  is  protected  against 
tuberculosis;  what  to  do  when  a  person  is  in  danger  of  contracting  the  disease, 
and  what  conduct  should  be  followed  by  patients  in  order  not  to  infect  those 
near  them.  The  Dispensary  for  lung  diseases,  where  medical  advice  and  medi- 
cines are  given  free,  and  the  league  against  tuberculosis  render  a  most  valuable 
co-operation  in  the  active  campaign  that  is  waged  in  Cuba  against  this  disease. 

Tuberculosis  is  not  the  only  disease  in  regard  to  which  the  Government  is 
trying  to  teach  the  people  to  prevent.  The  people  are  also  instructed  in  regard 
to  other  preventable  diseases,  for  which  purpose  pamphlets  have  been  issued 
containing  popular  instructions  regarding  the  procedure  to  be  followed  to  pre- 
vent the  infection  of  typhoid  fever,  scarlet  fever,  etc.  The  Official  Bulletin  of 
the  Department  of  Health,  to  which  I  have  just  referred,  contains,  not  only 
sanitary  and  demographic  statistics  and  weather  reports,  but  also  scienific  papers 
by  foreign  and  Cuban  professors.  I  have  the  honor  to  annex  herewith  the 
publications  to  which  I  have  referred,  for  the  information  of  my  distinguished 
colleagues. 

I  beg  to  inform  you  that  the  sanitary  conditions  of  our  interior  cities  and 
ports  are  excellent.  The  resolutions  passed  by  the  three  previous  Conferences 
have  been  enforced  and  health  officers  have  been  instructed  to  comply  with  them. 
Not  only  have  we  prevented  the  introduction  of  yellow  fever,  plague,  cholera, 
etc.,  but  also  succeeded  in  eradicating  a  long  time  ago  the  breaking  out  of 
yellow  fever  epidemics  initiated  in  Cuba  in  1905. 

A  no  less  remarkable  triumph  was  that  achieved  over  smallpox ;  this  universal 
disease,  which  reached  Cuba  through  a  thousand  different  ways,  is  unknown  to 
our  young  physicians,  because  not  one  single  case  has  appeared  in  Cuba  during 
the  last  ten  years,  if  exception  be  made  of  cases  treated  at  our  quarantine  sta- 
tions that  arrive  from  abroad. 

For  the  purpose  of  improving  sanitary  conditions  in  the  Republic,  there  are 
under  construction  in  different  cities  dredging,  water  supply  and  sewer  works, 
among  which  special  mention  should  be  made  of  the  sewer  system  of  the  city 
of  Havana,  the  cost  of  which  is  estimated  at  $16,000,000,  and  which  was  initiated 
three  months  ago. 

The  success  of  the  efforts  constantly  exerted  by  the  Department  of  Health  for 
the  betterment  of  public  hygiene  could  not  be  appreciated  unless  there  were 
tangible  facts  to  show  it;  and  as  an  apotheosis  of  such  facts,  we  submit  our 
rate  of  mortality.  During  the  first  six  months  of  the  present  year  our  average 
death  rate  has  ranged  between  12  and  14.44  per  thousand  annually,  a  figure  which 
by  itself  is  sufficient  to  place  the  Cuban  Republic  among  the  healthiest  nations 
in  the  world. 


FOURTH  INTERNATIONAL  SANITARY  CONFERENCE.  153 

REPORT  OF  DOCTOR  ALFONSO  QUInONES,  DELEGATE 
FROM  EL  SALVADOR. 

Mr.  President :  Messrs.  Delegates :  In  accordance  with  the  program  adopted 
for  this  Conference,  I  beg  to  submit  the  following  report  in  behalf  of  the 
Government  of  Salvador,  which  has  honored  me  with  its  representation  before 
this  learned  Assembly. 

I. 

The  Government  as  well  as  the  Superior  Board  of  Health  have  enacted 
measures  of  different  kinds  in  order  to  comply  with  the  stipulations  of  the 
three  previous  Conventions,  the  enumeration  of  which  provisions  would  be 
long;  the  most  important  ones  I  shall  have  occasion  to  cite  in  the  course  of 
the  present  report.  I  beg  the  Conference  to  glance  over  the  "Bulletin  of  the 
Superior  Council  of  Health,"  of  which  I  submit  the  collections  for  1908  and 
1909,  wherein  the  delegates  will  find  the  monthly  resume  of  the  provisions 
enacted  by  said  corporations  as  the  body  intrusted  with  the  supreme  control  of 
the  public  health,  and  in  compliance  with  the  requirements  of  the  Sanitary 
Code,  of  which  I  also  submit  two  copies.     It  has  been  in  force  since  1900. 

I  also  beg  to  present  pamphlets  containing  the  hygienic  regulations  for  rail- 
roads, tramways,  street  railways,  omnibuses  and  funeral  coaches ;  for  hotels^ 
bars,  confectioneries,  etc. ;  for  venereal  prophylaxis ;  the  provisions  of  Title  III 
of  the  Sanitary  Code,  which  establishes  medical  statistics;  the  inspection  of 
barber  shops,  unhealthy  premises,  and  schools.  Such  regulations  were  issued 
by  the  Executive  Power  on  different  dates,  and  they  contained  provisions  ade- 
quate to  each  case  and  in  conformity  to  the  special  services  of  the  country. 

Together  with  the  said  publications,  I  beg  to  submit  several  pamphlets, 
written  in  simple  language,  containing  instructions  for  the  prevention  of  infecto- 
contagious  diseases ;  the  following  publications  are  also  annexed  thereto : 

Directions  for  carrying  out  the  disinfection  prescribed  by  the  Superior  Council 
of  Health  of  France;  Directions  for  the  prevention  of  yellow  fever,  malaria  or 
intermittent  fever;  Rules  to  be  observed  by  famlies  in  cases  of  infecto-contagious 
diseases;  Preventive  measures  against  diphtheria;  The  teeth;  For  our  children 
when  they  are  eighteen  years  old;  Bubonic  plague;  Popular  instructions  regard- 
ing tuberculosis ;  Adventures  of  a  Koch  bacillus ;  Catechism  against  tuberculosis  ;. 
First  stage  of  Pulmonary  tuberculosis. 

II. 

VACCINATION    AND    SMALLPOX. 

Many  of  the  general  measures  above  stated  are  applicable  to  the  ports  of 
Acajutla,  La  Libertad,  and  La  Union,  the  principal  ones  in  the  country.  In 
these  ports,  as  is  the  case  with  all  Central-American  coasts,  malaria  is  the 
predominating  disease.  The  works  of  efficient  sanitation  will  cost  fabulous 
sums  and  it  would  be  even  materially  impossible  to  carry  them  out  so  long  as 
there  exist  the  virgin  forests  surrounding  them,  which  are  the  great  breeding 
place  of  all  sorts  of  mosquitoes.  However,  in  Acajutla,  the  most  important 
port,  it  being  connected  by  rail  with  the  capital,  there  is  under  conservation 
the  introduction  of  drinking  water  and  we  are  about  to  complete  the  drainage 
and  filling  in  of  the  large  swamps  surrounding  the  town,  by  means  of  the 
dredging  of  the  port ;  and  other  important  work  which  will  soon  be  finished  in 
the  same  port  is  that  of  the  deviation  of  the  river,  whose  floods  are  frequent. 

Since  1907  there  has  not  been  in  the  said  port  any  other  kind  of  epidemic 
nor  of  special  diseases. 

in. 

According  to  the  latest  statistics,  the  population  of  Salvador  is  1,070,555 
inhabitants ;  the  area  of  the  country  being  approximately  34,000  square  kilometers 
the  density  of  population  would  be  31.48  per  kilometer,  and  Salvador  is,  there- 
fore, one  of  the  most  densely  populated  countries  in  the  world. 


154 


FOURTH    INTERNATIONAL   SANITARY   CONFERENCE. 


In  tables  No.  2  and  3  are  the  proportions  of  births  and  deaths  for  the  years 
1907  and  1908.     The  resume  of  these  tables  is  as  follows : 


1907. 

Men. 

Births 22,561 

Deaths 12,939 

Women. 
21,660 
11,502 

Totals. 
44,221 
24,441 

Increase   of  population 

.     19,880 

1908. 

Men. 

Births 24,336 

Deaths 12,544 

Women. 
23,255 
12,147 

Totals. 
47,591 
24,691 

Increase   of  population 

.     22,900 

The  general  death  rate  is,  therefore,  23  per  cent  for  the  whole  country,  accord- 
ing to  the  Civil  Register  for  the  city  of  San  Salvador;  the  death  rate  during 
the  years  from  1895  to  1908  is  as  follows : 

Per  cent. 

1895 36.9 

1896 40 

1897 41.1 

1898 32.5 

1899 40.7 

1900 29.9 

1901  23.2 

1902 30.9 

1903  30.9 

1904 27.7 

1905 26 

1906 21.1 

1907 26.6 

1908 24.7 


The  death  rate  in  some  cities,  together  with  the  number  of  inhabitants  of 
each,  is  as  follows : 

Towns.  Population.  Death  rate  per  cent. 

Acajutla 1,200  54 

Sonsonate 16,752  35 

La  Union 3,984  31 

San  Salvador 57,024  27.7 

Jiquilisco 3,624  26 

La  Libertad 2,613  26 

Anuachapan   19,320  25 

Santo  Ana    53,024  23 

Santa  Tecia   17,640  22.7 

Zacatecoluca 19,488  22 

Apaneca 3,788  22 

San  Vicente 20,026  20 

Chalatenango 8,064  20 

San   Miguel    22,448  20 

Cojutepeque 14,184  16 

Sensuntepeque 11,216  16 

Jucuapa 9,360  13 

San    Francisco   Morazan 5,640  10 

(Statistics  of  1905.) 

Doctor  Pedro  S.  Fonseca,  Municipal  Engineer  of  the  capital,  is  about  to 
publish  The  Statistical  and  Demographic  Year  Book  of  the  city  of  San  Salvador 
for  1909;  this  publication  contains  much  important  data,  and  I  shall  send  it  to 
the  International  Sanitary  Bureau  of  the  American  Republics  in  Washington. 


FOURTH  INTERNATIONAL  SANITARY  CONFERENCE.  155 

IV. 

Since  the  Third  Sanitary  Convention  no  yellow  fever  case  has  been  noticed 
in  the  country. 

Neither  have  we  had  any  case  of  bubonic  plague.  Although  there  are  infected 
ports  south  of  us  the  small  conventional  relations  that  we  maintain  with  them 
and  the  circumstances  that  there  are  between  other  ports  of  Central  and  South 
America,  we  would  have  to  take  a  special  preventive  measure,  aside  from  the 
regular  medical  inspection  of  steamers,  which  inspection  is  more  rigid  in  cases 
of  vessels  that  have  come  directly  from  infected  ports  and  arriving  before  the 
period  of  ten  days  fixed  by  the  Sanitary  Code. 

Malaria  is  a  disease  prevailing  endemically  in  the  majority  of  the  towns  of 
the  country  and  appearing  at  all  seasons  of  the  j'ear,  with  well  pronounced 
exacerbations  at  the  beginning  and  the  close  of  the  rainy  season  and  under 
the  classically  known  forms  and  other  strange  ones.  We  are  now  trying  to 
better  the  local  conditions  of  every  town  by  draining  swamps  and  enforcing 
general  health  measures  tending  to  ameliorate  as  much  as  possible  that  constant 
and  dreadful  scourge  which  enervates  our  country  so  flagrantly,  and  which  is 
one  of  the  greatest  obstacles  to  agriculture,  industries  and  commerce ;  but 
hygienic  habits,  the  propaganda  of  new  ideas  concerning  infections  by  mosquito, 
and  preventive  and  curative  measures  are  gradually  taking  hold  on  the  lower 
classes  of  the  people,  so  much  so  that  many  places  formerly  dreaded  on  account 
of  their  lethality  have  greatly  improved. 

I  give  below  the  death  rate  of  malaria  in  some  towns  where  I  have  been 
able  to  obtain  the  statistics.  I  am  sorry  to  state  that  I  do  not  believe  that 
these  statistics  are  quite  correct,  because  even  in  the  capital,  where  there  are 
a  greater  number  of  physicians  and  more  means  of  support,  hardly  25  per  cent 
of  deaths  are  certified  by  doctors,  and  the  remaining  25  per  cent  die  without 
medical  assistance.  In  the  other  towns,  of  course,  there  is  less  accuracy  in  the 
diagfnosis  of  the  cause  of  deaths ;  to  these  we  should  add  the  indirect  deaths 
caused  by  malaria  under  other  forms : 

Acajutla 69.2 

Jiquilisco 42 

San   Francisco    34 

Zacatecoluca 28 

Sonsonate > 20 

La   Libertad    18.5 

Chalatenango 18 

Santa  Tecla    16.7 

La  Union 14 

San    Miguel    7 

Ahuachapan 7 

Apaneca 1.1 

Chinameca 0.80 

Santa    Ana    0.58 

Jucuapa  0 

The  morbidity  in  the  city  of  San  Salvador  may  be  estimated  at  45  per  cent 
in  some  sections,  with  a  general  mortality  of  6  per  cent. 

I  shall  now  speak  of  the  measures  against  tuberculosis,  one  of  the  diseases 
causing  the  highest  death  rate.  The  provisions  passed  by  the  Council  in  regard 
to  the  compulsory  registration  of  tuberculosis ;  the  bacteriological  laboratory, 
established  by  the  same  body  in  the  capital,  for  the  free  examiiiation  of  sputum 
of  suspected  persons ;  the  isolation  of  the  patients  in  hospitals  and  private 
wards;  the  disinfection  of  houses,  and  propaganda  of  special  hygienic  prescrip- 
tions, are  the  measures  adopted  for  the  purpose  of  preventing  that  disease. 

On  private  initiative  of  a  board  of  physicians,  and  by  popular  contributions, 
there  will  be  established  a  sanatorium  on  the  hills  south  of  the  capital,  at  a 
height  of  1,080  meters  above  the  sea  level,  provided  with  all  the  equipment 
necessary  for  this  kind  of  establishment.  The  plans,  which  have  already  been 
prepared,  show  that  the  building  will  have  a  capacity  for  one  hundred  patients 
of  the  white  plague. 


156  FOURTH    INTERNATIONAL   SANITARY   CONFERENCE. 

Smallpox. 

I  am  going  to  dwell  at  length  upon  the  campaign  waged  against  the  last 
epidemic  of  confluent  smallpox  that  occurred  in  the  earlier  part  of  the  current 
year. 

In  December,  1908,  the  epidemic  broke  out  in  the  west  of  the  Republic,  near 
the  Guatemalan  frontier;  it  assumed  alarming  proportions,  and  it  was  intro- 
duced by  laborers  imported  for  the  coffee  crop.  The  first  cases  reported  ap- 
peared in  "La  Gloria"  plantation,  within  two  leagues  of  Santa  Ana  in  the 
Canton  of  El  Portezuelo,  there  being  three  deaths  and  several  cases. 

The  Director-General  of  Vaccination,  Doctor  Rodolfo  B.  Gonzalez,  who  was 
Delegate  to  the  Third  International  Sanitary  Conference,  was  commissioned 
to  lead  the  fight  against  the  epidemic  and  immediately  proceeded  to  the  field 
of  battle,  together  with  the  necessary  personnel  and  elements. 

The  original  focus  of  the  epidemic  was  located,  and  very  energetic  measures 
of  isolation  and  disinfection  were  enforced.  Simultaneously  there  appeared  in 
the  city  of  Santa  Ana  three  cases  that  caused  two  deaths ;  a  lazaretto  was 
immediately  established  in  that  town,  in  which  the  first  patients  were  isolated. 
Meanwhile,  a  commission  presided  over  by  Dr.  Gonzalez,  made  a  tour  of  inspec- 
tion throughout  the  neighboring  cantons  for  the  purpose  of  enforcing  the 
measures  and  of  arresting  the  patients  who  were  trying  to  flee ;  126  of  them 
were  captured  and  confined  in  the  lazaretto  of  Santa  Ana. 

Another  lazaretto  was  established  in  La  Empalizada,  on  account  of  its  prox- 
imity to  the  canton  of  Comecayo,  which  was  the  most  infected  focus,  con- 
tiguous to  El  Portezuelo. 

These  first  measures  having  been  enforced,  six  medical  commissionrs,  accom- 
panied by  troops,  moved  towards  the  frontier  of  Guatemala,  with  orders  of 
maintaining  constant  telegraphic  communication  and  of  concentrating  in  a  point 
previously  set  by  the  chief.  The  result  of  this  search  was  the  discovery  of  a 
new  foci,  and  in  order  to  fight  them,  lazarettoes  were  established  in  Ahuachapan 
and  Chalchuapa,  46  patients  entering  in  the  former.  In  Antiquizaya  another 
lazaretto  was  established.  The  greatest  focus  was  found  in  the  neighborhood 
of  Santiago  de  la  Frontera,  where  154  patients  were  arrested  and  confined  in 
the  lazaretto. 

In  San  Jeromino,  near  Metapan  and  the  Guatemalan  boundary  line,  24  small- 
pox patients  were  found  and  confined  in  a  lazaretto  established  in  the  same 
place.  As  the  most  serious  and  dangerous  focus  was  that  of  Santiago  de  la 
Frontera,  a  sanitary  cordon  was  established  thereat  with  troops,  for  the  pur- 
pose of  preventing  propagation.  The  isolation  lasted  two  months;  during  that 
period  only  one  individual  violated  it,  availing  himself  of  a  forged  passport. 
He  was  apprehended  and  punished  in  accordance  with  the  sanitary  cordon. 
During  the  period  of  isolation  the  persons  within  the  radius  of  the  sanitary 
cordon  were  provided  with  clothing  and  food. 

The  houses  of  patients  were  disinfected  by  the  different  methods  recom- 
mended by  modern  hygiene ;  we  employed  with  good  success  and  great  economy 
the  method  recommended  in  the  Third  International  Sanitary  Conference  by 
Doctor  Liceaga,  called  "Victoria"  and  invented  by  Doctor  del  Rio  in  connec- 
tion with  the  campaign  against  yellow  fever  in  the  State  of  Tamaulipas,  Mexico, 
for  the  disinfection  of  shacks. 

Several  houses  and  shacks  which,  on  account  of  special  circumstances  could 
not  be  disinfected  in  one  way  or  another,  had  to  be  destroyed  by  fire,  previously 
indemnifying  the  owners. 

From  the  Honduran  frontier,  and  through  the  pilgrims  to  Esquipulas,  the 
towns  of  Chalatenango,  San  Pedro  Monulaco,  Tenancingo,  Guavava,  and  the 
capital  were  invaried  by  the  epidemic,  on  which  points  lazarettoes  were  estab- 
lished for  the  isolation  of  patients  without  spreading  the  disease.  In  the  "Con- 
cepcion  Ramirez,"  Plantation  Department  of  San  Vicente,  thirty  cases  were 
treated. 

The  greater  number  of  lazarettoes  were  made  of  tents,  and  we  tried  to  pro- 
vide them  with  all  necessary  elements  and  comforts. 

One  of  the  means  that  has  helped  to  ward  off  the  epidemic  was  vaccination 
and  revaccination,  which  was  exagerated  as  much  as  possible;  the  physicians 
rendered  the  service  free  of  charge,  assisted  by  vaccinators  who  traveled 
throughout  the  valleys  and  towns  of  the  whole  country. 


FOURTH  INTERNATIONAL  SANITARY  CONFERENCE.  157 

It  should  be  stated  that  we  had  little  trouble  in  vaccinating  the  people  because 
most  of  them  accept  vaccination  with  pleasure. 

Vaccination  and  revaccination  are  compulsory  in  Salvador. 

All  the  virus  that  was  used  was  animal  vaccine,  prepared  by  the  National 
Institute  of  Vaccine  annexed  to  the  Resales  Hospital,  which  institution  was 
opened  in  1907;  it  is  provided  with  all  necessary  equipment  and  since  its  open- 
ing it  has  been  under  the  direction  of  Doctor  Gustavo  S.  Baron,  and  his  first 
assistant.  Doctor  J.  D.  Juan  C.  Segovia,  who  have  under  them  the  necessary 
personnels. 

In  a  book  that  I  beg  to  submit,  entitled  "Rosales  Hospital,"  the  delegates  will 
find  illustrations  and  additional  information  in  regard  to  this  institution. 

In  normal  times,  one  calf  is  vaccinated  weekly  and  placed  under  observation 
during  several  days ;  from  each  calf  we  obtain  an  average  of  800  tubes,  the 
contents  of  which  are  sufficient  for  the  inoculation  of  five  or  six  persons.  But 
during  the  month  of  December,  1908,  and  January,  February  and  March,  1909, 
it  was  necessary  to  vaccinate  as  many  as  twelve  calves  per  week  in  order  to 
secure  the  sufficient  amount  of  virus  for  all  the  departments  and  even  the 
neighboring  Republics.  The  following  statistics  given  show  the  output  of  this 
interesting  institute  since  its  foundation  up  to  the  present  date : 

Tubes. 

1907 9,875 

1908 31,000 

1909 175,555 

Total 216,430 

It  is  also  just  to  make  mention  of  the  spontaneous  and  active  co-operation  that 
Doctor  Fernando  Lopez  rendered  establishing  an  institute  of  Vaccine  in  Santa 
Ana,  in  which  131  calves  were  inoculated  and  the  output  of  which  was  6,338 
c.  c,  of  excellent  virus. 

Ordinarily,  about  20,000  individuals  are  vaccinated  every  year ;  but  on  ac- 
count of  the  last  epidemic  we  may  estimate  that  87  per  cent  of  the  population 
have  been  vaccinated  and  revaccinated ;  and  we  have  every  reason  to  suppose 
that  when  all  the  statistical  data  for  the  present  year  has  been  compiled  that 
proportion  will  reach  90  per  cent. 

About  800  patients  were  treated  in  the  diflferent  lazarettoes,  of  which  10  per 
cent  were  of  hemorrhagic  confluent  smallpox,  26  per  cent  of  mild  smallpox,  and 
the  rest  of  confluent  smallpox.  The  deathrate  was  6  per  cent,  but  it  should 
be  stated  that  the  majority  of  deaths  occurred  among  cases  which  were  taken 
up  when  the  disease  was  already  far  advanced.  (I  beg  to  submit  some  photo- 
graphs of  the  most  remarkable  cases  and  of  pustules  produced  by  the  virus 
prepared  by  Doctor  Lopez.) 

Aside  from  the  usual  systematic  treatment  of  antithermic,  antipyretic  and  salt 
purgatives,  mouth,  nose  and  intestinal  disinfection,  we  adopted  as  general  treat- 
ment intramuscular  injections  of  an  acqueous  solution  of  corlagol  of  1  and  2 
per  cent,  injecting  from  1  to  6  c.  c,  and  as  many  as  15  centigrams  of  corlagol 
per  day,  not  injecting  more  than  1  c.  c.  each  time.  We  also  used  with  very 
good  results  colorgal  ointment  (Grede  formula)  at  the  stages  of  eruption  and 
suppuration. 

In  the  scaling  period  we  used  sterilized  olive  oil  mentholized  at  1  per 
cent,  and  the  patients  were  taken  to  a  special  lazaretto  for  convalescents;  before 
discharging  the  patients  they  were  given  a  bath,  new  clothing  and  two  pesos  and 
a  certificate  of  discharge.  With  the  treatment  above  explained,  applied  at  an 
early  stage,  the  fever  descends  after  the  first  injection;  the  general  condition  is 
improved ;  the  suppuration  is  extraordinarily  reduced,  not  appearing  in  many 
cases,  and  the  vesicles  dry  before  turning  into  pustules,  even  in  cases  of  very 
confluent  smallpox. 

It  should  be  pointed  out  that  not  one  single  individual  was  left  blind  as  a 
consequence  of  the  disease,  and  that  the  number  of  deaths  were  very  small, 
due  undoubtedly  to  the  fact  that  the  majority  of  the  inhabitants  were  vaccinated 
and  revaccinated. 

We  will  issue  at  the  end  of  the  present  year  an  illustrated  pamphlet  regard- 
ing the  smallpox  epidemic,  which  will  also  be  sent  to  the  International  Sanitary 
Bureau  of  the  American  Republics  in   Washington. 


158 


FOURTH    INTERNATIONAL  SANITARY   CONFERENCE. 


Before  closing,  due  mention  should  be  made  of  the  energetic  attitude  adopted 
by  the  President  of  the  Republic  who  interested  himself  personally  in  the  suc- 
cess of  so  arduous  a  campaign ;  of  the  Supreme  Council  of  Health,  for  its  wise 
measure;  of  the  Supreme  Council  of  the  Red  Cross,  which  furnished  all  the 
necessary  funds,  and  of  Doctors  Rodolfo  B.  Gonzalez,  Benjamin  Rodriguez 
and  Simon  Espinosa,  Jr.,  who  faced  the  situation  bravely  and  whose  success 
is  a  real  sanitary  victory  that  does  honor  to  the  Republic. 

I  beg  to  be  excused  for  having  made  such  a  minute  account  of  the  campaign 
against  smallpox,  having  had  two  powerful  reasons  to  do  so :  First,  that  it  was 
the  only  epidemic  that  broke  out  since  the  Third  Conference ;  and  second,  to 
show  that  in  Salvador  any  epidemic  invading  its  territory  can  be  successfully 
eradicated. 

Water- Supply — Sewers — Street  Paving. 

The  present  administration  of  the  Republic  being  convinced  that  water-supply 
in  towns  is  one  of  the  most  efficient  means  of  sanitation,  has  built  or  modified 
the  water-supply  of  several  towns,  through  the  Boards  of  Promotion  or  Water 
Boards.  Among  the  most  important  works  I  will  cite  the  following:  Cusca- 
tancingo,  Mejicanos,  Ayutucepeque,  Paleca,  San  Sebastian,  Aculhuaca,  San 
Marcos,  and  Sayapango,  towns  near  the  capital;  in  the  city  of  La  Union  and 
the  town  of  Conchagua,  in  the  Department  of  La  Union ;  Santiago  de  Maria 
and  Berlin,  Department  of  Usulutan. 

In  the  city  of  San  Vicente,  capital  of  the  Department  of  the  same  name,  the 
water-supply  system  has  been  enlarged  and  improved. 

In  the  city  of  Santa  Tecla  great  water-works  are  at  present  under  construc- 
tion to  change  the  old  system  for  a  new  one  of  better  grade  and  larger  capacity 
so  as  to  increase  the  water-supply,  thus  making  the  beautiful  "City  of  Hills" 
one  of  the  healthiest  in  the  country. 

It  is  gratifying  for  me  to  report  that  the  water-supply  system  of  the  capital, 
of  which  project  Doctor  Gonzalez  made  mention  in  the  Third  International 
Conference,  is  about  to  be  completed,  because  all  the  main  and  branch  pipes  have 
already  been  laid  out  in  the  city ;  there  is  only  the  roof  of  one  of  the  distribution 
tanks  to  be  finished.  With  this  important  improvement  the  capital  will  have 
6,0(X),000  liters  every  24  hours,  a  sufficient  amount  for  the  necessities  of  the 
whole  city. 

For  further  reference,  I  beg  to  submit  a  pamphlet  containing  the  plans  of 
said  waterways,  which  have  been  followed  in  every  detail.  The  cost  of  the 
system  up  to  date  amounts  to  nearly  $600,000. 

The  following  is  a  table  showing  the  old  water  system  of  other  towns  in  the 
Republic,  with  which  the  general  supply  of  water  will  be  completed: 


Towns. 

Population. 

Length  of 

San   Salvador 

57,024 

system. 

Origin. 

Sayapango 

3,576 

7,000 

Spring 

Ilopango 

2,232 

" 

San  Martin 

6,000 

" 

Tonaquetepeque 

7,056 

4,080 

" 

Apopa 

628 

" 

Santa  Ana 

48,280 

3,700 

" 

Texistepeque 

5,400 

2,500 

« 

Chalchuapa 

20,064 

(f 

Coatepeque 

12,192 

1' 

Metapan 

14,780 

<i 

Ahuachapan 

18,336 

a 

Atiquizaya 

9,576 

(t 

Sonsonate 

14,400 

« 

Nahuizalco 

12,960 

« 

Izalco 

12,432 

3,903 

River    San    Antonio 

Armenia 

9,432 

4,702 

Spring 

El  Progreso 

7,368 

(( 

Santa  Tecla 

17,544 

K 

La  Libertad 

2,160 

21,600 

I( 

Chalatenango 

8,016 

River 

Coquetepeque 

10,128 

1,009 

Spring 

San   Rafael 

4,032 

1,000 

« 

FOURTH  INTERNATIONAL  SANITARY  CONFERENCE. 


159 


Towns. 

Population. 

Length  of 

Suchitoto 

15,264 

System. 

Origin, 

Zacatecoluca 

17,592 

River 

San  Vicente 

19,752 

4,500 

Guadalupe 

3,120 

Spring 

Ilobasco 

11,352 

u  ° 

San   Miguel 

18,720 

« 

Chinameca 

12,552 

9,500 

« 

Jacuapa 

9,024 

« 

Santiago  de   Maria 

7,080 

« 

Alegria 

4,632 

<( 

Berlin 

8,736 

« 

Santa  Rosa 

6,528 

4< 

Tecoluca 

6,648 

« 

San   Julian 

3,550 

« 

Jayaque 

1,500 

« 

550 

It  should  be  stated  that  all  the  waters  of  these  towns  are  of  excellent  quality, 
as  shown  by  analysis,  the  waters  of  the  capital  being  distinguished  on  account 
of  the  high  proportion  of  Silitathat  they  contain,  about  0.  gr.  100  per  liter. 

The  capital  is  provided  with  a  sewer  system  the  length  of  which  is  14525 
meters. 

The  Board  of  Promotion,  upon  completion  of  the  water  system,  will  under- 
take the  construction  of  the  new  sewer  system,  to  which  end  it  has  already 
made  some  studies ;  it  will  probably  be  made  of  concrete,  which  system  offers 
many  good  advantages  in  its  application  to  this  city  of  earthquakes,  and  which 
is  becoming  more  general  in  the  construction  of  houses,  a  circumstance  which 
will  favorably  and  largely  modify  the  hygienic  conditions  of  the  city;  the 
municipality  has  already  corresponded  with  manufacturers  of  machinery  for 
making  blocks  and  it  is  expected  that  next  year  the  paving  of  streets  will  be 
undertaken,  adopting,  therefore,  the  system  offering  the  best  guaranties  of 
health,  durability  and  comfort. 

Venereal  Prophylaxis. 

Under  the  General  Bureau  of  Venereal  Prophylaxis  there  is  in  the  capital 
a  hospital  where  women  suffering  from  syphilitic  and  venereal  diseases,  ex- 
clusively, are  treated.  There  are  also  bureaus  in  Santa  Ana,  San  Miguel,  Son- 
sonate  and  Santa  Tecla. 

Number  of  registered 
women. 

San   Salvador    488 

Santa  Ana   83 

Sonsonate 47 

San    Miguel    50 

Santa    Tecla    72 

740 


Sanitary  Statistics.    Table  No.  1. 

1908  (Capital). 

Soft   chancres    280 

Hard   chancres    125 

Accidental  syphilis — 

Secondary   vulvar    40 

Secondary    anal    25 

Vaginal    blennorrhagia    150 

Gonorrheal    urethritis    125 

Gonorrheal   metritis    60 

Abscess  of  Bartholina  glands    35 


160  FOURTH    INTERNATIONAL   SANITARY   CONFERENCE. 

1909   (Capital). 

Soft   chancres    243 

Hard  chancres    65 

Accidental  syphilis — 

Secondary    vulvar    30 

Secondary  anal   15 

Vaginal  blennorrhagia   104 

Gonorrheal  urethritis 112 

Gonorrheal   metritis    40 

Abscess    of    Eartholina   glands 20 

F00USTt;FKS    AND    BEVERAGES. 

The  National  Legislative  Assembly  during  its  sessions  of  the  current  year 
enacted  a  law  providing  that  analysis  be  made  of  all  preserves,  liquors,  and 
beverages  in  general  imported  into  the  country,  and  creating  chemical  and 
biological  laboratories  in  the  ports  of  Acajutla,  La  Libertad  and  La  Union. 

The  municipality  maintains  a  laboratory  and  exercises  inspection  of  meats 
in  slaughter  houses  and  of  foodstuffs  in  markets. 

The  Chemical  Laboratory  of  the  Central  Board  of  Agriculture  has  made  all 
the  analysis  of  alcoholic  beverages  manufactured  in  the  country. 

Analysis. 

1907 385 

1908 522 

1909 383 

Total 1,290 

In  order  to  save  time  and  to  give  you  a  general  idea  of  the  sanitary  condi- 
tion of  the  country,  I  have  been  brief  in  some  points  of  this  report,  hoping  to 
be  able  to  explain  them  verbally  if  it  be  necessary. 


FOURTH  INTERNATIONAL  SANITARY  CONFERENCE.  161 

REPORT  OF  DOCTOR  NAZARIO  TOLEDO,  DELEGATE 
OF  GUATEMALA. 

Having  been  designated  at  the  last  moment  to  represent  the  Republic  of 
Guatemala  in  the  present  Conference  I  have  not  been  able  to  obtain  data  on  the 
work  accomplished  in  that  country  in  regard  to  the  sanitary  conditions  and 
improvements  of  its  sanitation  ;  nor,  much  less,  to  prepare  in  due  form  the  re- 
port required  by  the  provisional  program  upon  the  subjects  therein  specified; 
therefore,  I  beg  the  Delegates  to  excuse  the  deficiency  of  this  report,  promising 
to  furnish  the  necessary  additional  information  before  the  closing  of  the  Fourth 
Conference. 

As  the  ports  are  the  places  through  which  the  diseases  that  ravage  our  coun- 
tries are  introduced,  the  Government  of  Guatemala  has  given  preferential  at- 
tention to  the  betterment  of  hygienic  conditions  in  its  ports  open  to  inter- 
national traffic,  and  especially  in  Puerto  Barrios,  located  on  the  Atlantic  lit- 
toral, it  being  the  most  important. 

For  this  purpose  the  Government  provided,  during  the  recess  of  these  Con- 
ferences, for  the  expenditure  of  $2,000,000  in  sanitation  works  in  that  port, 
which  have  already  been  started ;  adequate  machinery  and  apparatus  for  the 
disinfection  of  merchandise  and  passengers  have  also  been  ordered. 

With  reference  to  the  sanitary  conditions  in  the  Republic  I  have  to  state 
that  the  endemic  diseases  which  cause  more  damage  in  the  country  are  typhoid 
fever,  tuberculosis,  eruptive  fevers,  especialy  smallpox,  and  in  the  coasts,  yellow 
fever.  In  regard  to  tuberculosis,  against  which  a  universal  campaign  has  been 
undertaken  that  will  diminish  its  propagation,  the  Government  of  Guatemala, 
mindful  of  its  humanitarian  duties,  has  taken  the  necessary  steps  to  establish  as 
soon  as  possible  a  sanatorium  duly  located  and  equipped,  and  in  the  meanwhile  a 
pavilion  in  the  General  Hospital  has  been  assigned  for  the  isolation  of  con- 
sumptives. 

In  regard  to  smallpox  and  on  account  of  the  epidemic  of  last  year  the  Gov- 
ernment took  very  energetic  and  opportune  measures  such  as  are  indicated  to 
fight  the  disease  and  prevent  its  spread,  with  very  satisfactory  results.  By  virtue 
of  a  national  law,  vaccination  is  compulsory;  there  are  establishments  for  the 
preparation  of  vaccine  in  the  principal  towns  situated  in  the  central,  oriental 
and  occidental  regions. 

In  some  towns  on  the  Atlantic  zone  there  were  several  cases  of  yellow  fever, 
for  which  reason  the  Government  increased  the  sanitary  surveillance  and  en- 
forced all  necessary  measures  for  the  isolation  of  patients  by  means  of  rooms 
protected  with  wire  gauze,  and  for  the  active  persecution  of  the  stegamya 
mosquito,  the  means  of  transmission  of  that  disease;  through  these  measures 
the  danger  was  overcome  and  the  propagation  of  the  disease  barred ;  and  it  can 
be  said  that  for  almost  two  years  not  one  single  new  case  of  yellow  fever  has 
appeared  in  Guatemala. 

The  General  Council  of  Hygiene  has  its  seat  at  the  Capital  of  the  Republic, 
and  is  composed  of  members  of  the  Faculty  of  Medicine  and  several  illustrious 
lawyers,  under  the  presidency  of  the  Dean  of  the  said  faculty.  Doctor  Ortega; 
there  are  in  the  principal  towns  of  the  Republic  boards  under  the  jurisdiction 
of  the  Council. 

Important  improvements  were  recently  introduced  in  the  Health  Service  of 
the  country,  the  most  interesting  of  which  are :  First,  the  change  of  the  pipes 
of  the  water  supply  system,  which  were  formerly  made  of  clay,  into  iron  pipes ; 
second,  the  improvement  of  the  water  used  in  the  same  supply;  third,  the  im- 
provement of  the  sewer  system,  now  provided  with  disinfection  apparatus. 

There  are  crematories  for  the  incineration  of  organic  substances  and  refuse 
collected  at  the  daily  cleaning  of  the  city. 

Besides  the  General  Hospital  there  is  one  for  lepers  at  two  miles  from  the 
Capital,  with  a  capacity  for  150  patients. 

Mention  should  also  be  made  of  the  Estrada  Asylum  for  convalescents;  an- 
nexed to  the  School  of  Medicine  is  a  department  of  "La  Gota  de  Leche"  for 
the  protection  of  children,  the  results  of  which  institution  have  been  very  satis- 
factory. 

The  time  for  the  reading  of  our  reports  being  limited,  I  close  this  brief  re- 
view of  the  Public  Health  of  Guatemala,  requesting  my  distinguished  colleagues 


162  FOURTH    INTERNATIONAL   SANITARY   CONFERENCE. 

to  excuse  the  omission  of  this  report,  which  shall  be  filled  within  the  shortest 
time;  I  take  advantage  of  this  opportunity  to  wish  the  greatest  success  to  the 
Fourth  Conference. 

I  now  have  the  honor  to  comply  with  my  offer  of  further  reporting  to  this 
learned  Conference  upon  the  health  conditions  in  the  Republic  of  Guatemala. 

The  general  health  has  been  satisfactory  throughout  the  Republic ;  last  year 
smallpox  appeared  in  isolated  cases  in  several  places  of  the  Republic,  but  the 
Government,  with  due  activity,  established  several  lazarettos  for  the  purpose  of 
isolating  the  patients  who  were  properly  treated  at  the  expense  of  the  Govern- 
ment. 

Vaccination  being  the  only  known  means  to  prevent  this  terrible  disease. 
Decree  No.  691,  of  December  8,  1908,  made  it  compulsory,  as  also  revaccination 
every  five  years,  there  have  been  established  in  the  Capital  of  the  Republic  in 
Quezaletenango  and  in  the  capital  of  the  Department  of  Progreso,  institutes  of 
animal  vaccine,  which  have  rendered  valuable  co-operation  in  eradicating  this 
disease  almost  completely,  because  no  new  cases  have  appeared  at  present. 

The  National  Institute  of  Vaccine  in  the  capital  is  provided  with  an  able 
personnel  and  equipped  with  the  necessary  instruments  imported  from  the 
United  States  and  from  Europe.  It  commenced  its  labors  in  June,  1908,  and 
since  then  it  has  manufactured  400,000  doses  of  vaccine  virus. 

A  remarkable  improvement  was  that  made  in  the  sanitation  of  the  coasts 
and  the  northern  departments  invaded  by  yellow  fever  in  previous  years. 

There  is  a  medical  corps  provided  with  all  the  necessary  elements  to  prevent 
that  disease  and  authorized  by  the  Supreme  Council  of  Health  to  adopt  all 
necessary  measures  of  prophylaxis.  During  1908  and  the  current  year  no  new 
cases  of  yellow  fever  have  been  registered.  Among  the  sanitation  works  that 
should  be  mentioned  are  the  following:  Introduction  of  drinking  water  in 
Gulan  and  the  establishment  of  a  lazaretto  in  the  same  town;  a  hospital  in 
Zacapa ;  a  quarantine  station  in  Puerto  Barrios  and  Livingston.  A  strict  sur- 
veillance has  been  established  over  all  points  liable  to  yellow  ferer  infections. 
The  Government,  whenever  necessary,  enacts  all  measures  tending  to  improve 
public  health.  The  opportune  quarantine  measures  are  also  being  taken  for 
the  purpose  of  avoiding  the  introduction  of  yellow  fever,  bubonic  plague,  and 
other  infectious  diseases  which  unfortunately  appeared  in  some  countries  of 
the  continent. 

By  virtue  of  a  contract  entered  into  with  the  Guatemala  Railroad  Company, 
that  corporation  will  undertake  important  preliminary  sanitation  works  in 
Puerto  Barrios.  This  preliminary  work  includes  many  excavations  and  fillings 
have  been  made ;  the  inhabitants  of  the  port  have  been  provided  with  abundant 
drinking  water  from  wells  purposely  opened,  and  the  works  are  carried  on  with 
great  activity,  it  being  already  noticeable  that  the  sanitary  conditions  have 
greatly  unproved,  for  which  reason  it  is  expected  that  Puerto  Barrios  will  soon 
be  not  only  one  of  the  safest  tropical  ports  but  also  one  of  the  healthiest. 

A  contract  has  also  been  recently  entered  into  between  the  Government  of  the 
Republic  and  the  United  Fruit  Company  by  virtue  of  which  the  latter  agrees  to 
undertake  the  permanent  sanitation  of  said  port,  which  works  will  cost 
$2,000,000.  They  include  water  supply  and  sewer  systems,  paving  of  streets,  and 
a  building  to  be  used  as  a  quarantine  station.  There  is  now  at  present  a 
provisional  station  equipped  with  all  necessary  scientific  apparatus  and  modem 
machinery  sufficient  for  the  service  required  by  the  present  traffic  of  the  port. 

The  disinfection  of  passengers,  baggage  and  vessels  coming  from  infected 
ports  is  duly  made  at  this  station. 

There  is  a  health  officer  in  each  port,  and  if  the  delegates  from  the  United 
States,  when  they  stopped  at  Puerto  Barrios,  had  no  occasion  to  see  the  health 
officer  thereat,  it  was  because  he  must  have  been  making  a  tour  of  inspection 
throughout  the  zone  under  his  jurisdiction,  and  that  is  the  reason  of  his  tem- 
porary absence.  The  ports  of  San  Jose  are  also  provided  with  a  medical 
service  and  with  the  necessary  elements  to  prevent  the  introduction  of  contagious 
diseases.  It  is,  therefore,  proven  that  there  is  a  health  officer  in  Puerto  Barrios 
and  that  his  absence  must  have  been  a  temporary  one. 

I  cannot  at  the  present  moment  furnish  any  statistical  data  in  reg^ard  to 
movement  of  population,  because  they  have  not  reached  me.  I  can,  however, 
inform  you  that  the  Bureau  charged  with  the  collection  of  general  statistics  has 
been    operating   continuously   during   the    sessions   of   the    Fifth    Pan-American 


FOURTH  INTERNATIONAL  SANITARY  CONFERENCE.  163 

Medical  Congress,  held  in  Guatemala  City  in  1908.  A  statistical  table  of  the 
diseases  prevailing  in  the  Republic  was  submitted. 

The  same  Bureau  is  now  actively  engaged  in  the  preparation  of  a  new  edition 
of  the  Political  Demarcation  of  the  Republic,  the  necessity  for  which  work 
being  widely  felt  on  account  of  the  modifications  that  have  taken  place  since 
1892,  the  year  of  the  publication  of  the  last  edition.  Preparations  are  also  being 
made  for  the  taking  of  the  General  Census  of  the  Republic  which,  for  justified 
causes,  was  not  made  at  the  time  prescribed  by  law.  Data  is  also  being  col- 
lected for  the  Guide  to  Immigrants,  which  will  be  published  when  the  new 
immigration  and  collection  law  is  promulgated. 

Before  closing,  it  behooves  me,  gentlemen,  to  state  that  the  Government  which 
I  have  the  honor  to  represent  in  this  illustrious  Convention  exerts  all  due  efforts 
to  comply  faithfully  with  all  the  provisions  enacted  by  the  three  previous  Con- 
ferences and  it  is  ever  willing  to  co-operate  to  the  realization  of  the  highly 
humanitarian  purposes  sought  by  this  Conference. 

A  proof  of  it  is  that  the  Republic  has  appointed  a  Representative  to  this  As- 
sembly, and  you  may  rest  assured  that  I  shall  do  my  best  to  help  you  in  the 
attainment  of  the  just  aspirations  of  the  Governments  interested  in  the  public 
health  of  the  American  Republics.  You  shall  have  my  unconditional  co- 
operation, and  though  it  be  true  that  I  cannot  bring  light  to  the  deliberations  of 
the  Conferences,  I  am  ready  to  confirm  and  accept  all  measures  and  resolutions 
that  may  be  the  result  of  our  discussions. 


FOURTH  INTERNATIONAL  SANITARY  CONFERENCE.  165 


REPORT  OF  DOCTOR  FERNANDO  VAZQUEZ,  DELEGATE 

OF  HONDURAS. 

In  my  capacity  as  delegate  from  the  Republic  of  Honduras  to  the  Fourth 
International  Conference  of  the  American  Republics,  I  have  the  honor  to  pre- 
sent  the   report  prescribed   by   the   provisional   program. 

1.  Since  the  last  Convention  no  special  sanitary  laws  have  been  enacted. 
There  is  a  strict  surveillance  in  ports  for  the  purpose  of  preventing  the  intro- 
duction into  the  country  of  persons  suffering  from  yellow  fever,  bubonic  plague, 
or  cholera;  this  service  is  in  charge  of  competent  physicians  who  inspect  all 
vessels  before  admitting  them  to  free  pratique.  Vaccination  against  smallpox 
is  compulsory  in  the  Republic,  by  virtue  of  a  law  promulgated  many  years  ago. 

2.  The  political  disturbances  that  the  country  has  experienced  during  the 
last  years  have  prevented  it  from  codifying  its  sanitary  laws,  but  the  administra- 
tion of  General  Davila  proposes  to  cause  such  a  codification  to  be  made  soon, 
and  after  its  completion  it  shall  be  sent  to  the  International  Bureau  at  Wash- 
ington. 

It  has  not  been  necessary  to  make  vaccination  compulsory,  because,  as  I 
stated  above,  all  inhabitants  are  obliged  to  vaccinate  themselves,  in  accordance 
with  a  law  that  has  been  in  force  for  many  years. 

The  bad  financial  condition  of  Honduras  has  not  permitted  the  Government 
to  declare  absolutely  free  of  fiscal  duties  qunine,  salts,  crude  petroluem,  wire 
gauze,  and  mosquito  nets;  but  such  duties  are  so  low  that  those  articles  are 
within  reach  of  all,  and  due  to  their  use  the  number  of  malarial  victims  has 
been  noticeably  reduced.  The  Government  has  exerted  special  efforts  in  edu- 
cating the  public  in  regard  to  the  etiology  of  malaria  and  in  popularizing  the 
prophylaxis  and  the  manner  of  fighting  diseases. 

Patients  of  trachoma  or  beri-beri,  are  not  admitted  in  the  ports  of  Honduras. 

The  use  of  carpets  and  curtains  is  prohibited  in  the  railroads  of  the  Republic; 
all  cars  are  provided  with  a  great  number  of  cuspidors,  and  they  are  always 
kept  clean  and  periodically  disinfected. 

There  are  no  special  hospitals  for  tuberculosis  patients,  but  the  general 
hospitals  are  provided  with  separate  pavilions  for  the  treatment  of  persons  suf- 
fering from  that  disease. 

3.  The  sanitary  conditions  of  the  two  principal  ports  of  Honduras,  are  not 
perfect ;  but  it  cannot  be  said  that  those  ports  are  unhealthy.  In  Amapala, 
a  port  on  the  Pacific  Ocean,  not  one  single  case  of  yellow  fever  has  ap- 
peared during  the  last  fifteen  years ;  the  last  invasion  took  place  in  1894,  I 
being  the  health  officer  who  fought  it ;  we  did  not  know  then  the  real  cause 
of  the  disease,  and  we  had  then  very  imperfect  elements  with  which  to  fight  it. 
By  isolation  and  cleanliness  we  succeeded  in  quenching  the  epidemic ;  in  later 
years,  with  a  perfect  knowledge  of  the  etiology  of  the  disease,  the  dreadful 
scourge  has  been  held  at  bay,  by  draining  swamps  and  covering  with  the  wire 
gauze  the  large  receptacles  for  rain  water  in  the  roofs  of  houses,  the  only 
source  of  drinking  water  that  there  is  in  the  town.  In  Puerto  Cortes,  on  the 
Caribbean  Sea,  the  crusade  against  the  stegoniya  mosquito  has  been  very 
energetic,  and  very  stringent  quarantine  measures  have  been  in  force,  in  accord- 
ance with  the  sanitary  authorities  of  New  Orleans;  in  spite  of  this  measure 
an  isolated  case  of  yellow  fever  appears  from  time  to  time,  but  its  propagation 
is  prevented  by  means  of  the  strictest  isolation. 

Malaria  ravages  both  the  littorals  and  is  the  most  formidable  enemy  of  public 
health  in  the  coasts  of  the  country;  but  the  fight  against  it  is  active  and  con- 
stant, and  thanks  to  it  we  will  be  able  to  control  the  disease. 

The  registration  of  the  movement  of  population  has  been  done  in  an  imperfect 
way  and  I  have  no  precise  data  in  regard  to  the  death  rate  in  the  country. 

Supplementing  the  report  that  I  presented  to  this  Convention  in  its  first 
session,  I  have  the  honor  to  add  some  data  that  I  have  just  received  from  the 
Government  of  Honduras.  Referring  to  the  first  point  of  the  provisional  pro- 
gram, relative  to  the  sanitary  laws  and  measures  of  my  country,  I  have  the 
pleasure  to  state  the  National  Executive  will  submit  to  the  Constitutional  Con- 
gress, in  the  next  ordinary  sessions,  a  project  for  a  Sanitary  Code,  a  copy  of 
which  I  annex  to  the  present  report.  The  said  Code  establishes  a  superior 
board  of  health,   with   headquarters   at   the  capital   of  the   Republic,   composed 


166  FOURTH    INTERNATIONAL   SANITARY   CONFERENCE. 

of  two  physicians,  one  pharmacist,  one  chemical  expert,  one  lawyer,  and  one 
engineer,  having  under  its  control  departmental  and  local  boards.  It  contains 
provisions  relatmg  to  the  Health  Service  of  frontier  towns  and  to  the  general 
health  service  of  departments;  to  Medical  Statistics,  to  Hygiene  of  Houses  and 
Schools,  to  Foodstuffs  and  Beverages,  to  Interior  Hygiene  of  Factories,  Barracks, 
Penitentiaries,  etc.,  to  the  inhumation,  exhumation  and  removal  of  ca- 
davers. It  also  contains  very  stringent  measures  for  the  isolation  of  cases  of 
infectious  and  contagious  diseases,  regulations  of  sanitary  police  with  regard 
to  animals,  to  hygiene  of  stables  and  slaughter  houses,  and  establishes  severe 
penalties  for  violations.  The  provisions  that  the  Code  contains  in  regard  to  the 
sanitary  administration  of  the  ports  of  the  Republic  are  very  complete,  and 
their  rigid  enforcement  will  safeguard  the  country  against  epidemics  from 
abroad  and  guarantee  the  health  of  countries  where  ships  coming  from  Hon- 
durean  ports  arrive.  In  the  principal  ports  there  will  be  disinfection  stations 
established  in  accordance  with  the  plan  that  may  be  designated  by  the  Superior 
Board  of  Health.  The  Code  has  an  appendix  containing  models  for  sanitary 
documents.  The  Government  of  Honduras  has  appealed  to  the  Sanitary  Con- 
vention of  Washington,  of  October  14,  1905,  which  will  be  declared  a  law  of 
the  Republic  in  the  next  sessions  of  the  Constitutional  Congress. 

With  reference  to  the  other  points  of  the  provisional  program  I  will  make 
mention  of  the  sanitation  of  cities  and  ports  saying  that  in  the  capial  of  Hon- 
duras there  is  a  perfect  system  of  sewers  and  water  supply,  as  also  in  the  cities 
of  Yuscaran  and  San  Pedro  Sula;  in  many  other  cities  of  the  country  water 
works  are  under  progress  and  in  many  of  them  under  construction. 

I  should  add  that  the  administration  of  General  Mig^uel  R.  Davila  does  its 
best  in  order  to  place  the  Republic  in  the  same  position  as  the  countries  which  are 
most  advanced  in  the  matter  of  public  health,  and  that  one  of  its  principal  aims 
is  to  banish  from  all  territory  all  infectious  diseases,  especially  malaria,  which 
is  the  scourge  of  the  Hondurean  coasts,  and  tuberculosis,  which  causes  every 
year  several  deaths  in  some  points  in  the  interior. 


FOURTH  INTERNATIONAL  SANITARY  CONFERENCE.  167 


REPORT  PRESENTED  BY  THE  DELEGATION  FROM 
MEXICO,  COMPOSED  OF  DOCTORS  EDUARDO  LI- 
CfiAGA  AND  TEStrS  MONTARAS. 

In  rendering  the  present  report,  which  is  a  resume  of  what  has  been  done 
in  the  Mexican  Republic,  the  delegation  will  follow  the  order  indicated  in  the 
Provisional  Program,  making  reference  only  to  the  points  relating  to  Mexico. 

1.  Reports  presented  by  different  delegates  in  regard  to  the  sanitary  regula- 
tions and  laws  adopted,  and  enforced,  in  their  respective  countries  since  the  last 
meeting. 

On  December  28,  1908,  there  was  promulgated  in  Mexico  an  Immigration 
Law,  which,  although  bearing  that  name,  refers  not  only  to  immigrants,  but 
also  to  all  foreigners  arriving  in  the  country  through  its  sea  ports  or  frontier 
cities.  » 

This  law  prohibits  the  admission  of  persons  suffering  from  bubonic  plague, 
cholera,  yellow  fever,  cerebro-spinal  meningitis,  typhoid  fever,  exanthematic 
typhus,  erysipelas,  measles,  scarlet  fever,  smallpox,  diphtheria,  or  any  other 
acute  disease  which  the  Executive  may  consider  transmissible. 

It  also  prohibits  the  admission  of  persons  suffering  from  tuberculosis,  lep- 
rosy, beri-beri,  trachoma,  Egyptian^  mange,  or  any  other  chronic  disease  that 
the  Executive  may  consider  transmissible. 

The  admission  of  the  following  is  also  prohibited :  Epileptics,  insane,  old, 
feeble,  deformed,  lame,  maimed,  hunch-back,  paralytic,  blind,  or  otherwise 
crippled  persons,  or  those  who  through  any  physical  or  mental  defects  are 
unfit  for  work  and  may  become  a  public  charge;  prostitutes  or  individuals  who 
intend  to  introduce  them  into  the  country  for  the  purpose  of  exploiting  them 
or  of  living  at  their  expense. 

The  law  prevents  the  admission  of  other  foreigners,  of  whom  we  do  not 
make  mention  because  there  prohibition  does  not  refer  to  purely  hygienic 
subjects. 

Of  course,  there  are  exceptions  in  some  of  these  cases,  but  guarantees  are 
then  required  so  that  the  immigrants  or  foreigners  thus  excepted  may  not 
become  a  public  charge. 

Shipping  and  immigration  companies  are  held  pecuniarily  responsible  for  the 
violation  of  the  law,  whether  such  violation  be  committed  by  the  companies 
themselves  or  by  their  agents. 

The  same  law  establishes  the  rules  to  which  ships  transporting  passengers 
to  the  ports  of  the  Republic  shall  be  subjected,  and  prescribes  which  cases 
should  be  removed  to  the  lazarettos  or  to  the  sanitary  stations,  and  those 
which  cannot  be  admitted  by  any  means. 

The  law  deals  separately  with  immigrant  laborers  and  with  immigration 
companies,  defining  who  are  immigrant  laborers ;  it  prescribes  the  ports  es- 
pecially designated  for  the  arrival  of  immigrants  when  their  number  exceeds 
ten,  and  establishes  the  rules  to  which  ships  conveying  immigrants  shall  be 
subjected. 

The  Immigration  Service  is  directly  under  the  Department  of  the  Interior, 
which  administers  this  branch  by  means  of  special  officers,  such  as  immigra- 
tion inspectors,  assistant  agents,  and  immigration  boards. 

All  violations  of  the  law  are  tried  before  the  Federal  Courts. 

The  regulations  of  this  law  were  issued  on  February  25th  of  the  present  year, 
and  they  contain  in  detail  the  provisions  regarding  the  manner  in  which  pas- 
sengers and  immigrant  laborers  shall  be  received  in  the  seaports,  and  the 
rules  governing  passengers  on  land ;  they  also  prescribe  the  administrative 
jurisdiction  in  the  matter  of  immigration. 

From  the  above  it  will  be  seen  that  the  law  to  which  we  refer  not  only  prO' 
tects  the  Mexican  Republic  against  transmissible,  acute  or  _  chronic  diseases, 
but  also  in  providing  for  its  own  defense,  protects  the  nations  which  main- 
tain relations  with  us  by  land  or  sea. 

II.  Special  report  by  each  official  delegate  regarding  the  manner  in  which 
the  resolutions  adopted  in  the  previous  Conventions  have  been  put  into  prac- 
tice in  their  respective  countries. 

We  will  take  up  separately  the  resolutions  adopted  in  each  one  of  the  three 
Sanitary  Conventions. 


168  FOURTH    INTERNATIONAL   SANITARY   CONFERENCE. 

FIRST    CONVENTION. 

The  most  important  resolution  was  to  the  effect  that  the  Convention  should 
be  governed  by  the  resolutions  approved  by  the  Second  Pan-American  Con- 
ference, held  in  Mexico  in  1901-02.  As  the  resolution  refers  to  the  Convention 
itself,  the  delegation  will  not  report  upon  it;  but  we  will  state  that  it  has  been 
faithfully  observed  in  all  the  Conventions. 

The  second  resoluion  provides  that :  "That  the  time  of  detention  and  of  in- 
spection at  maritime  quarantine  stations  shall  be  the  least  practicable  time 
consistent  with  public  safety  and  in  accord  with  scientific  precepts." 

Mexico  has  enforced  quarantine  only  during  the  epidemic  of  bubonic  plague 
that  took  place  in  Mazatlan ;  with  regard  to  yellow  fever  in  the  Gulf  ports,  it 
does  not  establish  quarantine ;  the  vessels  are  detained  only  the  necessary 
time  for  making  the  disinfection  and  sanitary  inspection  of  passengers,  and 
suspected  non-immunes  are  not  subjected  to  observation,  but  they  are  simply 
watched  by  the  sanitary  and  civil  authorities,  because  our  nation  has  always 
maintained,  both  before  scientific  congresses  and  conventions  and  in  practice, 
this  principle:  "To  defend  the  interests  of  public  health,  without  injuring,  or 
doing  the  least  possible  injury  to,  the  nations  dealing  with  that  which  adopts 
the  measures  of  defense,  but  always  basing  such  measures  upon  the  principles 
of  sanitary  science." 

With  regard  to  the  third  resolution,  Mexico  has  modified  its  procedure  for 
receiving  vessels  in  its  ports,  in  the  case  of  yellow  fever,  since  the  confirmation 
of  the  doctrine  of  the  transmission  of  these  diseases  by  means  of  the  stegomya 
mosquito ;  therefore  it  can  be  said  that  Mexico  has  faithfully  complied  with 
this  provision. 

With  reference  to  the  fourth  resolution,  the  Government  has  continued  study- 
ing the  geographical  distribution  of  the  stegomya  mosquito  in  order  to  estab- 
lish sanitary  services  in  the  places  where  these  mosquitoes  exist,  with  a  view 
to  eradicating  yellow  fever  when  it  appears,  or  to  prevent  its  appearance. 

Mexico  complied  strictly  with  the  provisions  of  the  fifth  resolution,  when 
fcubonic  plague  invaded  the'  port  of  Mazatlan.  It  has  not  been  necessary  to 
enforce  those  measures  in  any  other  town,  because  since  the  summer  of  1903 
not  one  single  case  of  plague  has  been  recorded  in  the  whole  country. 

The  sixth  resolution  refers  to  the  manner  in  which  the  discharges  of  cases 
of  typhoid  or  cholera  should  be  treated.  As  cholera  has  not  appeared  in  the 
Republic  since  1883,  it  has  not  been  necessary  to  take  special  preventive 
measures  against  this  disease,  aside  from  those  contained  in  the  Sanitary  Code. 
As  regards  typhoid  fever,  it  is  provided  that  rooms  where  cases  have  occurred 
and  the  discharges  and  all  articles  soiled  therewith  must  be  disinfected.  As 
the  seventh  resolution  refers  to  the  duties  of  the  International  Sanitary  Bu- 
reau, it  only  behooves  us  to  state  that  Mexico  has  regularly  contributed  with 
the  quota  assigned  to  it  for  the  maintenance  of  the  International  Bureau  of  the 
American  Republics. 

SECOND  CONVENTION. 

With  reference  to  the  third  resolution,  paragraph  (b),  the  Mexican  Dele- 
gation can  assure  that  the  plan  of  defense  against  the  propagation  of  yellow 
fever  has  been  established  since  1903;  that  it  has  acted  in  accordance  with 
paragraph  (c),  promptly  reporting  all  the  cases;  with  regard  to  paragraph  (f), 
that,  since  1894,  the  quarantine  services  are  under  the  control  of  the  Federal 
Government,  and  that,  since  1903,  the  campaign  against  yellow  fever  is 
managed  by  the  Federal  Government  itself,  with  the  assistance  of  some  of  the 
States  of  the  Republic. 

With  regard  to  the  Sanitary  Convention  signed  at  Washington  on  the  14th  of 
October,  1905,  we  will  say  that  it  has  constantly  been  complied  with  by  the 
Government  of  the  Mexican  Republic. 

THIRD  CONVENTION. 

As  to  the  second  resolution,  Mexico  has  codified  its  sanitary  legislation  in  a 
Sanitary  Code  of  the  Mexican  United  States,  since  1891,  and  in  the  Regula- 
tions of  Maritime  Sanitation  referring  to  International  Sanitary  Police,  dated 
in   1894. 

With  reference  to  the  fifth  resolution  we  beg  to  report  that  vaccination 
against  smallpox  is  compulsory  in  Mexico  since  1891. 


FOURTH  INTERNATIONAL  SANITARY  CONFERENCE.  169 

The  free  admission  of  quinine  salts,  wire  guaze,  crude  petroleum  and  mosquito 
netting,  referred  to  in  the  sixth  resolution,  has  not  been  as  yet  provided  for, 
but  such  articles  are  freely  distributed  in  all  places  where  yellow  fever  formerly 
prevailed  and  where  there  are  malaria  patients. 

Referring  to  the  seventh  resolution,  Mexico  has  carried  on  the  propaganda 
therein  recommended  by  establishing  leagues  against  malaria  and  yellow  fever  in 
Campeche,  Coatzacoalcos,  Cordoba,  Merida,  Progreso,  Salina  Cruz  and  Laguna 
del  Carmen,  and  by  means  of  lectures  for  the  purpose  of  propagating  the  doctrine 
of  the  transmission  of  both  diseases  through  mosquitoes;  a  special  agent  was 
also  detailed  to  lecture  along  the  Pacific  coast  on  the  said  doctrine. 

Mexico  has  likewise  complied  with  the  eighth  resolution  by  buying  great 
quantities  of  quinine,  which  the  Government  distributes  freely,  not  only  for  the 
treatment  of  patients,  but  also  as  a  prophylactic  means,  among  persons  exposed 
to  malaria. 

In  pursuance  to  the  eleventh  resolution,  Mexico  has  published  pamphlets 
regarding  the  transmission  of  malaria  and  yellow  fever  and  containing  advices 
for  preventing  the  infection  by  said  diseases.  These  pamphlets  contain  brief, 
simple  and  practical  instructions  so  that  the  doctrine  may  become  known  to  all 
social  classes,  and  they  have  been  widely  distributed. 

With  reference  to  the  twelfth  resolution,  we  beg  to  state  that  immigrants 
afflicted  with  trachoma  or  beri-beri  are  not  admitted  to  the  country. 

Referring  to  the  fourteenth  resolution,  we  will  say  that  Mexico  has  not  yet 
succeeded  in  organizing  a  Department  of  Public  Health,  but  the  sanitary  au- 
thorities are  working  with  that  end  in  view.  Practically,  however,  the  services 
of  public  health  are  centralized  in  the  Department  of  the  Interior,  in  all  that 
related  to  the  Federal  Districts  and  Territories,  to  the  Gulf  and  Pacific  ports 
and  to  the  frontier  towns ;  and  also  in  the  states  in  what  relates  to  the  preven- 
tion of  the  spread  of  epidemic  diseases. 

In  the  campaign  against  yellow  fever  the  States  of  Yucatan,  Campeche, 
Chiapas,  Tabasco,  Oaxaca,  Vera  Cruz,  and  Tamaulipas  intrusted  the  Federal 
Government  with  the  direction  of  said  campaign.  When  the  epidemic  of  bubonic 
plague  appeared  in  Mazatlan  the  States  on  the  Pacific  littoral  likewise  intrusted 
the  Federal  Government  with  the  direction  of  the  campaign  against  that 
disease. 

The  campaign  against  tuberculosis,  referred  to  in  the  thirteenth  resolution, 
was  initiated  in  Mexico  many  years  ago. 

Reports  in  regard  to  sanitary  conditions  in  ports  and  measures  proposed  for 
the  improvement  of  such  sanitary  conditions  {with  special  reference  to  the 
principal  ports). 

As  the  report  presented  by  the  Mexican  delegation  to  the  Third  Sanitary 
Convention,  held  in  Mexico,  contained  a  very  detailed  account  of  the  sanitary 
conditions  in  the  principal  ports  of  the  country,  especially  in  those  of  Tampico, 
Vera  Cruz,  Coatzacoalcos,  Manzanillo  and  Salina  Cruz,  we  beg  to  refer  the 
Conference  to  said  report,  adding  only  that  the  Federal  Government  has  just 
authorized  the  negotiation  of  a  loan  of  1,000,000  pesos  for  the  completion  of 
the  sanitary  works  in  the  port  of  Tampico. 

In  the  report  alluded  to  we  stated  the  amount  spent  by  the  Federal  Govern- 
ment in  Mexico  City  and  other  towns  of  the  Republic,  with  a  total  of 
$45,831,361.64,  to  which  should  be  added  the  amount  of  $831,913.06  inverted 
after  the  Convention  of  Mexico,  and  $1,000,000  recently  authorized  for  Tampico. 
Therefore,  the  Federal  Government  has  spent  in  the  sanitation  of  its  ports, 
of  the  city  of  Mexico  and  of  other  towns,  the  sum  of  $47,633,374.70. 

Besides  these,  the  cities  of  Monterey,  Guadalajara,  Puebla,  and  Oaxaca. 

Reports  relating  to  the  registration  of  the  movement  of  population  and  the 
rate  of  mortality  in  each  country,  specifying  those  in  ports  and  principal  cities. 

We  have  not  been  able  to  comply  with  this  provision  because  the  new  census 
of  the  entire  Republic  will  not  be  taken  until  1910,  and  not  before  then  will  we 
be  in  a  position  to  send  to  the  countries  that  signed  with  Mexico  the  Sanitary 
Convention  of  1905  the  Mortality  Statistics,  that  is  to  say,  the  proportion  of 
the  number  of  its  inhabitants  in  a  city  and  the  number  of  deaths  occurred  in 
the  year  1910. 

V. — Sanitation  of  cities  and  especially  of  ports. 

In  paragraph  5  of  the  report  presented  by  this  delegation  to  the  Third  Sanitary 
Convention  an  account  is  made  of  the  sanitation  of  the  principal  ports  and  cities. 


170  FOURTH    INTERNATIONAL   SANITARY   CONFERENCE. 

In  order  to  comply  with  this  part  of  the  program  the  Mexican  Delegation 
has  the  honor  to  explain  the  methods  followed  in  Mexico  and  for  that  purpose 
believes  that  it  can  do  no  better  than  to  transcribe  the  article  relating  to  that 
point  which  is  contained  in  the  Sanitary  Code  of  1891,  and  the  further  develop- 
ment of  the  principles  of  that  article  in  the  Maritime  Sanitary  Regulations  which 
have  been  in  force  since  the  year  1894. 

The  former  reads  as  follows : 

"Art.  22.  Whenever  any  vessel  is  about  to  leave  a  Mexican  port  the  Delegate 
of  the  Supreme  Board  of  Health  will  proceed  to  make  the  official  visit  which 
is  required  under  the  Maritime  Sanitary  Regulations,  and  will  issue  the  Bill  of 
Health  showing  the  hour  at  which  it  is  issued." 

The  Maritime  Sanitary  Regulations  contain  the  following: 

"Art.  57.  The  Delegate  will  deliver  the  bill  of  health  to  the  Master  or 
Ship's  Doctor  only  after  making  his  last  official  visit  in  order  that  he  may  set 
forth  therein,  of  his  own  personal  knowledge,  the  sanitary  condition  of  the 
ship,  passengers,  crew  and  susceptible  merchandise. 

"Art.  58.  Bills  of  health  will  be  issued  free  of  charge  to  foreign  war  vessels, 
and  without  expressing  their  destination. 

"Art.  60.  Every  master  or  port  agent  of  a  vessel  about  to  proceed  to  sea 
will  apply  in  writing  to  the  Port  Delegate,  or  to  the  official  who  may  represent 
him,  for  the  clearance  of  his  vessel,  giving  the  following  data:  Class  of  vessel; 
nationality ;  registered  tonnage ;  names  of  master  and  doctor,  if  any ;  number 
of  crew;  number  of  passengers,  in  transit  and  received  in  the  port;  cargo 
received  therein ;  ports  of  call ;  final  destination  and  exact  hour  of  departure. 

"Art.  61.  The  application  referred  to  in  the  preceding  article  shall  be  delivered 
to  the  Delegate  of  the  Board  at  least  three  hours  before  departure  of  the 
vessel  in  order  that  this  officer  may  have  time  to  inspect  the  principal  depart- 
ments of  the  vessel,  have  them  disinfected  if  necessary,  change  the  water  in 
the  bilge,  if  it  appears  to  him  desirable,  ascertain  the  sanitary  condition  of  the 
crew  and  passengers,  and  take  all  other  steps  which  may  be  necessary  so  that 
the  vessel  sailing  from  a  Mexican  port  may  do  so  in  a  good  hygienic  condition. 

"The  sanitary  authority  who  may  represent  the  Delegate  in  ports  of  the 
fourth  class  will  make  the  official  visit  before  departure,  issue  the  Bill  of  Health, 
and  if  he  finds  anything  which  requqires  it,  he  will  report  to  the  Board  in 
order  that  it  may  decide  what  is  to  be  done  under  the  circumstances. 

"Art.  63.  All  vessels  leaving  Mexican  ports  shall  comply  with  the  following 
requisites : 

"I.  The  food  carried  on  board  shall  be  of  a  good  quality,  under  such  condi- 
tions that  it  can  be  kept  in  a  good  state,  and  sufficient  in  quantity  for  the 
number  of  persons  in  the  crew  and  passengers  in  proportion  to  the  days  which 
the  voyage  is  to  last. 

"II.  The  vessel  shall  carry  a  sufficient  quantity  of  drinking  water  in  propor- 
tion to  the  number  of  days  the  voj'age  is  to  last. 

"III.  The  staterooms  and  sleeping  berths  for  the  passengers  and  crew  shall 
be  of  sufficient  capacity  to  prevent  crowding. 

"IV.  The  water  in  the  bilge  shall  be  in  good  condition  and  shall  be  renewed  if 
found  to  be  infected. 

"V.  Whenever  allowed  by  the  capacity  and  construction  of  the  ship  there 
shall  be  a  proper  place  for  the  isolation  of  persons  suffering  from  contagious 
diseases. 

"VI.  Whenever  the  kitchen  utensils  are  made  of  copper  they  shall  be  properly 
tinned. 

"VII.  There  shall  be  a  medicine-chest  equipped  with  all  the  necessary 
medicines. 

"VIII.  The  vessel  shall  be  equipped  with  the  most  indispensable  disinfectants 
for  its  own  sanitation  in  the  event  of  its  being  infected. 

"IX.  The  life-saving  equipments  must  be  in  good  condition  and  proportioned 
to  the  number  of  persons  carried  by  the  vessel. 

"X.  The  general  condition  of  cleanliness  of  the  ship  and  crew  must  be 
satisfactory. 

"XI.  The  toilet-rooms  must  be  supplied  with  a  proper  disinfectant. 

"XII.  They  shall  not  carry  any  persons  on  board  who  are  suffering  from  any 
transmissible  diseases  mentioned  in  these  regulations,  and  should  any  pas- 
senger be   suspected   of  tuberculosis  the   Master  will   be   requested  to   make   a 


FOURTH  INTERNATIONAL  SANITARY  CONFERENCE.  171 

special  disinfection  of  the  stateroom  and  clothing  whenever  such  passenger 
leaves  the  vessel. 

"Art.  65.  Merchants  who  ship  susceptible  goods  from  Mexican  ports  are  re- 
quested to  have  them  disinfected  so  as  to  avoid  the  necessity  of  quarantine." 

Furthermore,  in  dealing  with  cases  of  yellow  fever,  it  is  provided  that  the 
vessel  shall  be  fumigated  whenever  moored  near  the  wharf  or  mosquitos  are 
found  on  board. 

As  can  be  seen,  all  possible  precautions  are  taken  for  the  protection  of  pas- 
sengers leaving  Mexican  ports,  not  only  when  such  ports  are  infected,  but  also 
under  any  circumstances  whatever. 

DISCUSSION    OF    MEASURES    AGAINST    THE    INTRODUCTION    OF 

DISEASES  NOT  INCLUDED  IN  THE  CONVENTION 

OF  WASHINGTON  OF  1905. 

The  Convention  of  Washington  makes  provision  for  measures  against  plague, 
cholera,  and  yellow  fever  only.  The  Mexican  Republic  protects  itself  against 
other  diseases  besides,  such  as,  among  the  acute  ones,  cerebro-spinal  meningitis, 
typhoid  fever,  exanthematic  typhus,  erysipelas,  measles,  scarlet  fever,  smallpox, 
and  diphtheria,  and  the  Federal  Executive  reserves  the  right  to  include  any 
other  acute  disease  that  he  may  consider  transmissible. 

Among  the  chronic  diseases  the  immigration  law  includes  tuberculosis,  leprosy, 
beri-beri,  trachoma,  Egyptian  mange,  or  any  other  chronic  disease  that  the 
Executive  may  consider  as  a  transmissible  one.  The  law  also  prohibits  the 
admission  of  epileptics,  insane,  old,  feeble,  deformed,  lame,  maimed,  hunch- 
back, paralytic,  blind  or  otherwise  crippled  persons,  or  those  who  through  any 
physical  or  mental  defects  are  unfit  for  work  and  may  become  a  public  charge. 

The  measures  of  protection  against  transmissible  diseases  are  contained  in 
the  following  articles  of  the  Sanitary  Code : 

"Art.  26.  The  prophylaxis  measures  in  Mexican  ports  for  the  purpose  of 
preventing  the  introduction  of  epidemic  and  transmissible  diseases  shall  be : 

"1st.  Sanitary  medical  inspection  of  vessels; 

"2d.  Surveillance,  or,  if  necessary,  isolation  of  suspected  passengers; 

"3d.  Isolation  of  patients  until  they  have  completely  recovered,  in  lazarettos  or 
remote  places; 

"4th.  Disinfection  of  vessels,  baggage  and  merchandise  whenever  necessary; 

"5th.  Destruction  of  animals  transmitting  infection. 

"Art:  27.  The  prophylactic  measures  referred  to  in  the  preceding  article  shall 
be  subject  to  the  provisions  of  the  Maritime  Health  Regulations,  and  power  is 
given  to  the  Supreme  Board  of  Health  and  its  Delegates  in  the  ports  to  detain 
vessels  as  long  as  necessary  while  said  measures  are  carried  out. 

"8th.  Sanitary  models  or  forms  to  be  adopted  by  nations  forming  part  of  this 
Convention." 

For  the  information  of  the  Delegates  we  annex  to  this  report  copies  of  the 
models  used  in  the  Mexican  Republic  for  the  entry  of  vessels  and  for  bills  of 
health. 


172 


FOURTH    INTERNATIONAL   SANITARY   CONFERENCE. 


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FOURTH  INTERNATIONAL  SANITARY  CONFERENCE.  173 

REPUBLIC  OF  MEXICO. 
Port  of 


Saniury  Delegation.  Shipping  Entries. 

Name  and  class  of  vessel 

Nationality 

Reg^istered  tonnage 

Name  of  Master   

Name  of  Doctor 

Number  of  crew 

Number  of  passengers  in  transit 

Number  of  passengers  for  this  port 

Port  the  ship  cleared  from 

Name  of  consignee 

Port  the  passengers  embarked  in 

Days  from  first  port  of  departure 

Ports  touched  at 

Days  from  last  port  touched  at 

Tons  of  cargo  for  this  port,  with  classification  of  goods 


Tons  of  cargo  in  transit  with  specification  of  goods 

Port  of  shipment  of  cargo  contained  in  ship 

Has  the  ship  any  sick  people  on  board  ?    If  so,  what  is  the  disease  ? 

Has  there  been  any  sickness  on  the  voyage?    If  so,  with  what  disease?. 


Were  any  sick  persons  received  on  board  in  ports  touched  at?     If  so,  what  was 

their  disease  ?    

Have  any  deaths  occurred  during  the  voyage  ? 

What  was  the  cause  of  death  ? 

Has  any  communication  taken  place  with  another  ship  during  the  voyage? 

Where  was  that  ship  bound  for,  of  what  character  was  the  communication  and 

how  long  did  it  last  ? 

What  was  the  sanitary  condition  of  that  ship  ? 

Did  she  proceed  from  an  infected  or  suspected  port  ? 

Was  any  person  or  cargo  transhipped  ? 

If  cargo  was  transhipped,  specify  the  class  of  goods  and  where  they  came  from? 

Does  your  cargo  contain  old  rags? cotton  waste? tanned  hides? 

feathers  ? hides  and  furs  ? horse  hair  or  bristles  ? 

horn  and  hoof  animals? wool? goods  manufactured  of  wool. 

but  not  packed  ? 

Exact  time  when  the  ship  anchored  ? 

All  of  which  I  certify  to  in  the  port  of 

this day  of 19 


174  FOURTH   INTERNATIONAL   SANITARY   CONFERENCE. 

SUPREME   COUNCIL   OF   HEALTH    OF   MEXICO. 
Sanitary  Delegation. 
I  have  to-day  issued  to 


bill  of  health  for  a  national  port  and for  a  foreign  port 

Which  I  have  the  honor  to  communicate  to  you  for  your  information  and 
subsequent  purposes. 

Liberty  and  Constitution. 

of  the  month  of ,  19.. 


Physician.  Delegate. 

To  the  Collector  of  Customs  at 


SUPREME  COUNCIL  OF  HEALTH. 
Sanitary  Delegation. 

There  anchored  at  this  port  to-day 

.of registered  tonnage, 

this  being national  port  at  which  it  touched. 

Which  I  have  the  honor  to  communicate  to  you  for  your  information  and 
subsequent  purposes. 

Liberty  and  Constitution. 

of  the  month  of ,  19.. 


Physician.  Delegate. 

To  the  Collector  of  Customs  at  the  port  of 


FOURTH  INTERNATIONAL  SANITARY  CONFERENCE,  175 

REPORT  OF  DOCTOR  BELISARIO  PORRAS,  DELEGATE 

FROM  PANAMA. 

I  have  had  the  honor,  of  which  I  am  not  worthy,  of  being  designated  by  the 
President  of  the  Republic  of  Panama  as  a  Delegate  with  Full  Powers  to  repre- 
sent the  said  Republic  in  this  International  Conference,  and  I  now  have  the 
privilege  to  submit  to  your  consideration  a  succinct  report  in  regard  to  the 
Sanitary  Laws  and  Measures  in  force  in  my  country  since  the  last  International 
Sanitary  Convention :  in  regard  to  the  manner  in  which  the  resolutions  passed 
by  the  three  previous  Conferences  have  been  put  into  practice ;  to  the  sanitary 
conditions  of  our  ports,  and  to  the  other  points  of  the  Provisional  Programme 
of  this  Conference. 

A. 

I. — Since  the  last  International  Sanitary  Conference,  held  in  Mexico  on  De- 
cember 7,  1907,  Panama  has  complied  most  faithfully  with  all  the  prescriptions 
relating  to  infectious  diseases.  It  may  be  said,  by  the  way,  that  since  1907  the 
Isthmus  of  Panama  has  been  free  from  yellow  fever,  smallpox,  bubonic  plague 
and  other  quarantinable  diseases.  The  last  case  of  yellow  fever  occurred  in 
November,  1905 ;  and  the  last  suspected  case  of  the  same  disease  appeared  in 
May,  1906.  Therefore,  the  sanitary  works  carried  on  in  the  Isthmus  by  the 
illustrious  Colonel  G.  Gorgas,  Chief  Health  Officer  of  the  Canal  Commission, 
in  regard  to  quarantine,  clearly  show  the  eflfects  and  advantages  of  modern 
sanitation,  undertaken  with  the  intelligent  application  of  proven  facts  with 
regard  to  the  propagation  of  diseases. 

I  will  enumerate  briefly  the  sanitary  laws,  regulations  and  measures  in  force 
in  Panama,  Colon,  and  Canal  Zone,  promulgated  in  1904,  and  modified  from 
time  to  time  in  order  to  adapt  them  to  circumstances. 

(1)  Water-supply  systems  have  been  established  in  the  cities  of  Panama  and 
Colon  and  all  along  the  Canal  Zone.  All  water  receptacles  which  might  have 
become  breeding  places  for  mosquitoes  have  been  removed  and  destroyed. 
Modem  systems  have  also  been  established,  and  small  towns  and  neighboring 
districts  are  provided  with  pail  systems  for  the  disposal  of  fecal  matter.  The 
streets  of  Colon  and  Panama  have  been  paved  in  such  a  way  that  only  those 
of  the  principal  capitals  of  Europe  and  the  United  Sttaes  could  be  compared 
to  some  of  them;  there  are  macadamized  roads  throughout  the  Canal  Zone. 

(2)  For  the  improvement  of  sanitary  conditions  in  towns  and  lands  near 
the  camps  on  the  Canal  Zone  an  extensive  drainage  system  has  been  installed 
for  the  purpose  of  diminishing  as  much  as  possible  the  accumulation  of  stagnant 
water,  thus  facilitating  the  extermination  of  mosquitoes,  and,  consequently,  the 
prevention  of  diseases  transmitted  in  the  cities  of  Colon  and  Panama  is  very 
small,  so  much  so  that  it  may  be  said  that  there  are  no  longer  any  mosquitoes; 
the  remarkable  decrease  in  the  number  of  those  called  siegomya  calopus  render 
Panama  and  Colon,  as  well  as  the  Canal  Zone,  virtually  safe  from  the  yellow 
fever.  All  swamps,  wells,  and  other  places  where  mosquitoes  might  breed  are 
constantly  inspected  and  treated  with  crude  petroleum  or  Phinotas  Oil,  which 
give  the  best  results  in  the  destruction  of  the  larvae. 

(3)  There  is  a  good  system  for  the  disposal  of  garbage  or  refuse  by  means 
of  metallic  pails  which  are  perfectly  air-tight.  These  pails  are  removed  and 
emptied  by  the  Qeaning  Department  every  twenty-four  hours. 

(4)  Adequate  provisions  have  been  enacted  for  regulating  the  construction 
of  new  buildings.  In  accordance  thereto,  all  buildings  must  be  provided  with 
ventilation,  drainage  and  light,  and  in  the  city  they  must  have  connections  with 
the  water-pipes  and  the  sewer  system.  The  same  regulations  provide  that  all 
buildings  shall  be  rat-proof.  This  is  a  wise  measure  because  it  reduces  the 
number  of  rats  and  prevents  the  introduction  of  bubonic  plague.  All  plans  for 
new  buildings  must  be  approved  by  the  health  authorities. 

There  are  also  in  force  regulations  regarding  the  construction  of  stables, 
providing  that  they  must  be  built  in  accordance  with  hygienic  principles  so 
that  they  shall  not  become  breeding  places  of  rats. 

(5)  Regulations  governing  the  raising  and  slaughter  of  cattle,  sheep,  hogs, 
and  other  animals  for  public  consumption,  and  the  sale  of  food  products;  markets 
and  other  places  where  articles  of  food  are  sold  are  carefully  inspected. 


176  FOURTH    INTERNATIONAL   SANITARY   CONFERENCE. 

The  sanitary  regulations  prescribe  that  all  houses  and  sites  be  kept  clean  and 
in  good  sanitary  condition,  and  the  inspectors  of  the  Department  of  Health  see 
to  it  that  such  regulations  are  faithfully  complied  with. 

(6)  Regulations  compelling  the  immediate  registration  of  contagious  dis- 
eases, such  as  diphtheria,  scarlet  fever,  measles,  smallpox,  etc.,  are  so  rigidly 
enforced  that  the  notification  is  received  immediately  after  each  case  appears; 
upon  receipt  of  such  notice  the  case  is  immediately  isolated,  and  the  necessary 
disinfection  made. 

(7)  There  are  strict  regulations  to  prevent  the  incubation  of  mosquitoes  in 
houses,  prohibiting  the  use  of  cans,  pails,  tubs,  and  other  similar  receptacles, 
under  penalty  of  a  fine. 

During  the  last  eighteen  months  an  active  crusade  has  been  waged  against 
rats,  by  means  of  poisons  and  traps,  with  a  view  to  the  destruction  of  those 
rodents,  and  of  placing  the  ports  in  as  good  a  sanitary  condition  as  possible 
from  the  point  of  view  of  bubonic  plague. 

B. 

II. — With  reference  to  the  sanitary  conditions  in  the  ports  of  the  Republic,  I 
will  say  that  a  very  strict  quarantine  service  is  maintained  against  infected 
ports,  and  all  vessels  arriving  therefrom,  as  well  as  those  having  cases  on 
board,  are  carefully  inspected  before  being  admitted. 

In  Panama  a  large  quarantine  station  has  been  built,  provided  with  a  floating 
disinfecting  plant,  for  disinfection  by  means  of  sulphurous  gas,  steam,  and  for- 
maldehyde gas.  In  Colon  there  is  a  provisional  quarantine  station  equipped 
with  the  necessary  means  of  fumigating  and  disinfecting  of  vessels  and  bag- 
gage.    A  large  permanent  quarantine  station  will  soon  be  built  in  the  latter  port. 

In  Bocas  del  T?oro,  another  port  of  entry,  there  is  maintained  a  quarantine 
service,  and  some  of  the  works  have  been  carried  on  in  the  same  manner  and 
under  the  same  regulations  above  mentioned. 

The  law  making  vaccination  compulsory  is  also  in  force,  and  all  persons  who 
establish  their  residence  in  the  cities  of  Panama  and  Colon  and  in  the  Canal 
Zone  must  be  vaccinated,  unless  they  have  already  been  protected  against 
smallpox  by  recent  vaccination. 

From  the  above  it  will  be  seen  that  the  resolutions  by  previous  conferences 
have  been  complied  with  in  Panama  and  have  been  in  force  since  1904. 


III. — The  sanitary  condition  of  the  ports  and  of  the  Canal  Zone  are  most 
satisfactory.  As  I  have  said  before,  they  are  provided  with  water-supply  and 
sewer  systems,  and  kept  clean.  Each  section  is  under  the  supervision  of  a 
Health  Officer  who  has  under  him  the  necessary  number  of  Health  Inspectors 
and  employees.  The  evident  proof  of  all  this  lies  in  the  fact  that  not  one 
single  case  of  yellow  fever  or  bubonic  plague  has  occurred  since  1905,  and  that 
when  in  1906  there  were  a  few  cases  of  smallpox  in  Colon,  brought  by  a  child 
from  Cartagena,  the  disease  was  quickly  controlled  and  no  propagation  took 
place  outside  of  the  inhabitants  of  the  house  occupied  by  the  sick  child,  and 
of  two  neighboring  houses. 

Next  year  the  work  of  enlarging  the  paving  of  the  streets  of  Colon  will  be 
undertaken,  as  well  as  the  construction  of  the  water-supply  and  sewer  systems. 
In  Panama  the  paving  of  streets,  the  water-supply  system  and  the  sewer  system 
will  also  be  enlarged.  The  cost  of  these  improvements  will  be  $800,000,  of  which 
$300,000  will  be  spent  in  Panama  and  $500,000  in  Colon.  The  sanitary  condi- 
tions and  especially  the  results  of  sanitation  are  clearly  proven  by  the  death  rate 
in  those  districts,  which  is  as  follows : 

D. 

IV. — In  order  to  have  reliable  data  in  regard  to  the  movement  of  pooulation 
a  detailed  census  has  twice  been  taken ;  that  census  has  been  rectified  by  the 
immigration  statistics,  compiled  monthly  by  the  Departments  of  Immigration 
and  Quarantine,  and  shows  the  exact  number  of  persons  that  come  in  and  go 
out  of  the  country;  therefore,  the  increase  in  population  as  shown  by  such 
figures  is  correct. 


FOURTH  INTERNATIONAL  SANITARY  CONFERENCE.  177 

The  best  way  of  showing  this  increase  in  population  and  the  death  rate  is  to 
give  here  the  figures  for  the  years  from  1905  to  1909,  inclusive: 

Population   of   the 
Zone,    Panama  Population    of  Population    of  Atinual 

Year.  and  Colon.  Panama.  Colon.  death  rate. 

1905  56,624  22,000  11,000  50  per  1,000 

1906  73,000  25,000  13,000  48  per  1,000 

1907  102,000  33,000  14,000  33  per  1.000 

1908  120,000  37,000  15,000  24  per  1,000 

1909  142,000  43,000  18,000  19  per  1,000 

E. 

V. — Referring  further  to  the  quarantine  regulations,  I  can  affirm  that  in  my 
country  all  sorts  of  preventive  measures  are  enforced  in  ports  of  entry  for  the 
purpose  of  avoiding  the  introduction  of  diseases  by  means  of  infected  vessels  or 
cargo  or  passengers  from  infected  ports.  In  the  majority  of  cases  protective 
measures  are  taken  by  employees  of  the  quarantine  service  in  the  ports  of  origin. 
The  ship  is  fumigated  in  the  infected  port  before  leaving  for  the  port  of  the 
Republic  of  Panama ;  passengers  and  their  baggage  are  carefully  examined  and 
disinfected  when  necessary.  The  shipment  of  merchandise  which  may  be  liable 
to  transmit  infection  is  prohibited. 

It  should  be  noted  that  with  the  observance  of  such  measures  in  the  port  of 
origin,  which  is  done  under  the  supervision  of  a  delegate  physician  attached  to 
the  consulate  at  the  port  of  clearance,  the  ship  leaves  such  port  with  a  clean 
bill  of  health,  so  that  the  time  which  it  consumes  in  the  trip  can  be  counted  for 
the  purposes  of  quarantine,  and  passengers  from  ports  infected  with  yellow 
fever  or  bubonic  plague  who  may  have  been  four  days  in  the  water  are  only 
detained  two  days,  that  is  to  say,  the  necessary  time  to  complete  the  period 
of  quarantine  prescribed  for  the  disease,  counted  from  the  date  of  sailing  to  that 
of  arrival.  Upon  arrival,  passengers  or  other  persons  on  board  ship  who  have 
not  completed  the  period  of  quarantine  during  the  voyage  are  removed  to  the 
quarantine  station  to  be  detained  for  a  number  of  days  necessary  to  complete 
said  period.  Should  a  ship  arrive  with  a  case  on  board,  against  which  no 
protective  measures  were  taken  in  the  port  of  origin,  the  quarantine  measures 
prescribed  by  the  Convention  are  observed. 

Since  passengers  arriving  from  infected  ports  are  considered  as  coming  from 
infected  centers,  in  accordance  with  the  articles  of  the  Convention,  such  pas- 
sengers are  not  allowed  to  proceed  to  neighboring  countries  until  they  have 
completed  the  period  of  quarantine  in  Panama,  because  if  they  were  permitted 
to  do  .«;o  they  would  be  a  serious  danger  to  neighboring  ports  and  other  countries. 

F. 

VI. — With  preference  to  the  forms  and  models  that  should  be  adopted  by  the 
nation  that  take  part  in  the  International  Sanitary  Convention,  paragraph  two 
of  the  Convention  of  Washington,  which  prescribed  regulations  for  baggage  and 
merchandise,  makes  no  mention  of  one  kind  of  cargo  which,  in  the  opinion  of 
experts  on  the  subject,  is  extremely  dangerous,  and  such  is  all  merchandise 
which  might  aflFord  food  for  rats.  Under  this  classification,  cereals,  grains, 
bran,  etc.,  might  be  included. 

The  second  point  in  regard  to  this  subject  which  is  worthy  of  consideration  is 
that  concerning  the  indemne  ship.  According  to  the  Convention  of  Washington 
a  ship  is  considered  indemne  when,  although  coming  from  an  infected  port, 
she  has  had  neither  death  nor  case  of  plague  cholera,  or  yellow  fever  on  board, 
either  at  the  time  of  departure,  during  the  voyage,  or  at  the  time  of  arrival. 
Article  twenty-three  provides  that  ships  indemne  from  plague  ought  to  be 
admitted  to  free  pratique  immediately,  whatever  may  be  the  nature  of  their  bill 
of  health.  The  measures  governing  such  ships  are:  Disinfection  of  soiled 
linen,  articles  of  wearing  apparel,  and  other  personal  effects  of  the  crew  and 
passengers,  but  only  in  exceptional  cases;  and  destruction  of  rats  by  fumiga- 
tion, if  the  sanitary  authorities  deem  it  necessary. 

If  only  a  minimum  of  measures  is  enforced  against  indemne  ships  it  may 
he  clearly  seen  that  if  infection  existed  on  board,  either  in  infected  rats  or  in 


178  FOURTH    INTERNATIONAL   SANITARY   CONFERENCE. 

infected  wearing  apparel,  and  passengers  are  allowed  to  disembark  immediately 
after  the  fumigation  or  disinfection  of  the  ship  they  would  naturally  have  been 
exposed  to  infection  of  bubonic  plague  up  to  the  very  time  when  disinfection 
took  place,  and  therefore  they  would  be  apt  to  develop  the  disease  within  any 
time  during  the  five  days  following  their  landing.  The  question  relating  to 
indemne  ships  is,  according  to  data  obtained  by  the  illustrious  physicians  at  the 
head  of  public  hygiene  in  my  country,  Gorjas,  Peary  and  Pierce,  of  far  greater 
importance,  and  articles  of  the  Convention  relating  thereto  should  be  more  care- 
fully studied  and  given  a  wider  scope.  These  distinguished  physicians  opine  that 
if  the  history  of  the  introduction  of  bubonic  plague  in  clean  and  healthy  ports  be 
examined,  it  will  be  seen  that  almost  always  the  propagation  of  that  disease 
was  due  to  the  so-called  indemne  ships. 

Therefore,  it  would  be  very  advisable  to  investigate  if  five  days  are  a  suffi- 
cient period  of  quarantine  for  bubonic  plague.  Many  countries,  including  Japan, 
prescribe  a  longer  and  more  rigid  quarantine.  Some  cases  of  bubonic  plague 
are  developed  five  days  after  they  had  been  exposed  to  infection. 

Summing  up  the  subjects  of  the  provisional  program  of  the  Sanitary  Con- 
vention of  American  Republics,  I  beg  to  report  the  following: 

I. — The  sanitary  measures  in  force  in  the  Republic  of  Panama  since  the  last 
Conference,  outside  of  those  enacted  by  the  Chief  Health  Officer  of  the  Isthmian 
Canal  Commission,  in  regard  to  sanitation  on  land  and  the  regulations  of  the 
Public  Health  and  Marine  Hospital  Service  of  the  United  States,  in  regard  to 
quarantine  measures,  special  circulars  have  been  issued  from  time  to  time; 
amending  quarantine  measures  for  special  ports  according  to  the  changes  in 
the   sanitary   conditions   thereof. 

n. — The  Government  of  Panama  and  the  sanitary  authorities  of  the  Canal 
Zone  have  faithfully  observed  and  complied  with  the  resolutions  approved  by 
the  three  previous  Conferences,  Article  IX,  paragraph  11,  chapter  1,  of  the 
Convention  ad  referendum  concluded  in  the  Second  International  Sanitary 
Conference  of  Washington,  on  October  14,  1905,  speaking  of  the  time  when 
an  area  should  no  longer  be  considered  infected,  says  that  "each  government 
may  reserve  the  right  to  extend  this  period."  The  health  officers  of  Panama 
have  found  it  necessary  to  considerably  extend  that  period  as  regards  the  deten- 
tion of  passengers  coming  from  places  where  bubonic  plague  or  yellow  fever 
have  prevailed,  as  well  as  the  disinfection  of  baggage  of  passengers  coming 
from  places  where  the  existence  of  bubonic  plague  is  suspected ;  they  have  also 
prohibited  the  landing  of  merchandise  which  may  be  liable  to  produce  infection. 

III. — The  sanitary  conditions  in  all  parts  of  the  Republic  and  in  the  principal 
cities,  Panama  and  Colon,  are  excellent.  The  projected  improvements  to  be  car- 
ried out  in  the  cities  of  Panama  and  Colon  are  many  and  extraordinary,  and 
it  is  with  pleasure  that  I  submit  to  my  illustrious  colleagues  the  reports  pub- 
lished in  "The  Canal  Record"  of  November  3d  and  17th  in  regard  to  said 
measures. 

IV  and  V. — Exact  information  in  regard  to  all  passengers  arriving  at  the 
principal  ports  is  always  recorded.  The  Quarantine  and  Immigration  Service 
in  Colon  publishes  annually  a  comprehensive  report  on  this  subject.  That  of 
1908  is  very  remarkable  and  interesting.  I  beg  to  submit  to  my  illustrious 
colleagues  a  paper  showing  the  death  rate,  the  population,  and  special  statistics 
in  Panama  and  Colon. 

VI. — There  are  no  infected  ports  in  the  Republic.  Passengers  arriving  at 
the  Isthmus  are  examined  by  officers  of  the  Public  Health  and  Marine  Hospital 
Service  of  the  United  States  whenever  they  are  present. 

From  the  above  you  can  judge  the  wonders  realized  in  my  country  in  this 
project  of  sanitation,  thanks,  undoubtedly,  to  the  wisdom,  the  perseverance,  and 
the  power  of  the  American  Government,  to  which  Panama  intrusted  at  the 
dawn  of  its  independence  so  important  a  service  of  public  life.  Twelve  years 
have  scarcely  elapsed  since  that  date,  and  to-day  that  proverbial  and  universal 
reputation  of  Panama  as  an  unhealthy  country  has  completely  disappeared, 
and  we  can  now  affirm  emphatically,  without  fear  of  exaggeration,  that  what 
was  before  a  focus  of  infection  of  all  known  diseases  is  now  a  paradise  from 
the  point  of  view  of  sanitation,  where  men  of  all  races,  climates,  and  regions 
of  the  globe  can  immigrat*,  prosper,  and  be  happy. 


FOURTH  INTERNATIONAL  SANITARY  CONFERENCE.  '   179 

QUARANTINE  OPERATIONS  IN  COLON  DURING  1908. 

Number  of  ships  inspected  and  admitted 792 

Number  of  ships  fumigated  upon  arrival 3 

Number  of  ships  fumigated  before  departure 1,371 

Number  of  pieces  of  baggage  disinfected 51,172 

Number  of  members  of  crew  examined 53,328 

Number  of  passengers  examined 104,500 

Number  of  persons  vaccinated  upon  arrival  at  the  port 11,894 

Number  of  persons  vaccinated  at  the  port  of  departure  or  during  the 

voyage 16,262 

Number  of  persons  detained  in  the  quarantine  station  to  complete  the 

incubation  of  yellow  fever 2,107 

Number  of  persons  detained  in  the  quarantine  station  to  complete  the 

period  of  incubation  of  bubonic  plague S3 

Number  of  persons  detained  on  board  ship 1,405 

Number  of  persons  arriving  from  foreign  ports — cabin  passengers  14,154, 

and  steerage  passengers  33,973 48,127 

Number  of  persons  sailing  for  foreign  ports — cabin  passengers  12,602, 

steerage  passengers  15,006  27,608 

Number  of  persons  in  transit 12,727 

Number  of  persons  in  coast  towns,  examined 2,474 

Number  of  persons  in  coast  towns,  not  examined 2,092 

Number  of  persons  leaving  Colon  for  coast  towns 1,951 

Number  of  persons   disembarked   during  the  month :   for  immigration 

into  the  Isthmus,  38,799 ;  for  Pacific  ports,  3,914 42,693 

Number  of  viseed  bills  of  health 187 

Number  of  persons  recommended  for  deportation 115 


IMMIGRATION    STATISTICS   RELATIVE   TO    COLON   DURING    1908. 

Passengers. 

From —                                                                          Cabin.  Steerage. 

European  ports   498  1,471 

United  States  8,742  874 

Jamaica  and  West  Indies 1,820  11,124 

Guatemala 95  11 

Venezuela 46  26 

Colombia 520  1,617 

Cuba 145  211 

Costa  Rica   1,057  1,442 

Bocas   del   Toro 129  2,345 

Coast  towns  0  2,092 


13,052  21,213        34,265 


CONTRACT   LABORESS  : 


From  Barbados   2,229 

From  Spain  1,989 

From  Guadalupe   296  4,514 


Total 38,779 

Men 26,091 

Women 7,498 

Children 3,098 

Not  classified   2,092 

38,779 


180 


FOURTH   INTERNATIONAL   SANITARY   CONFERENCE. 


DEATHS  IN  THE  CITIES  OF  PANAMA  AND  COLON  AND  IN  THE 

CANAL  ZONE,  1908. 

Population. 

Panama Z7,Wi 

Colon 15,878 

Canal  Zone   67,146 


120,097 


Deaths. 

Average  per 
1,000. 

1,292 

418 

1,273 

24.83 
26.32 
18.95 

2,983 


24.83 


IMPROVEMENT  THAT  HAS  BEEN  ACCOMPLISHED. 


Year.  Population. 

1904 35,000 

1905 42,699 

1906 66,011 

1907 102,133 

1908 120,097 


Rate  per 

Deaths. 

1,000. 

1,224 

52.45 

2,793 

65.41 

3,544 

49.10 

3,435 

33.63 

2,983 

24.83 

DEATH  RATE  AMONG  EMPLOYEES  OF  THE  CANAL  COMMISSION 
AND  OF  THE  PANAMA  RAILROAD. 

September :  Per  1,000. 

1904 14.31 

1905 32.40 

1906 57.34 

1907 28.63 

1908 12.78 

1909 12.76 


AVERAGE  OF  SPECIAL  DISEASES. 


Dysentery  . 1906 

Dysentery 1907 

Dysentery 1908 

Malaria 1906 

Malaria 1907 

Malaria 1908 


69  deaths  among  26,705  employees. 

48  deaths  among  39,343  employees. 

16  deaths  among  43,890  employees. 
233  deaths  among  26,705  employees. 
154  deaths  among  39,343  employees. 

73  deaths  among  43,890  employees. 


Of  typhoid  fever  there  were  in  1907,  98  deaths;  in  1908,  19.  Of  pneumonia 
there  were  431  deaths  in  1906;  328  in  1907,  and  93  in  1908.  The  last  case  of 
yellow  fever  in  the  Isthmus  occurred  in  November,  1905.  The  last  case  of 
bubonic  plague  in  the  Isthmus  took  place  in  Augfust,  1905.  There  have  been  no 
cases  of  smallpox  since  1906. 


FOURTH  INTERNATIONAL  SANITARY  CONFERENCE.  181 

REPORT  OF  THE  DELEGATES  FROM  THE  UNITED 

STATES. 

The  delegation  of  the  United  States  to  the  Fourth  International  Sanitary 
Convention  of  American  Republics  submitted  the  following  reports  provided 
for  in  the  provisional  program  issued  June  14,  1909: 

REPORT  OF  SANITARY  CONDITIONS  BY  SURGEON-GENERAL 
WALTER  WYMAN,  U.  S.  PUBLIC  HEALTH  AND  MARINE-HOS- 
PITAL SERVICE. 

I.      REPORT   ON    SANITARY    LAWS   AND   REGULATIONS    ADOPTED    IN    THE    UNITED    STATES 

SINCE  JANUARY  1,  1908. 

In  this  summary  I  propose  first  to  give  an  idea  of  the  laws  and  regulations 
that  have  been  passed  since  our  last  convention. 

No  special  Federal  laws  in  regard  to  sanitary  matters  have  been  enacted 
by  the  National  Congress  since  the  Convention  of  1907,  with  the  exception  of 
two  laws  of  local  application  to  the  District  of  Columbia.  One  of  these  Acts, 
approved  April  20,  1908,  authorized  the  Commissioners  of  the  District  to  pro- 
mulgate regulations  governing  the  establishment  and  maintenance  of  private 
hospitals  and  asylums,  and  required  these  institutions  to  be  licensed  by  the 
Commissioners  in  whom  was  also  vested  the  power  to  revocate  these  licenses. 
The  other  Act  approved  May  13,  1908,  providing  for  the  registration  of  all 
cases  of  tuberculosis  in  the  District,  was  patterned  after  the  tuberculosis  law, 
passed  in  the  State  of  New  York,  and  described  below,  the  only  important  devia- 
tion from  the  same  is  the  extension  of  the  period  allowed  the  physician  to 
report  cases  under  his  care  to  7  days  instead  of  24  hours. 

Police  power  with  respect  to  sanitation  within  the  States  has  been,  as  is 
well  known,  reserved  by  the  States  themselves.  In  the  46  States  and  2  Terri- 
tories now  forming  the  Union,  a  number  of  laws  relative  to  public  health  have 
been  passed  during  the  last  two  years,  the  most  important  being  briefly  ab- 
stracted here : 

Tuberculosis. — In  the  State  of  New  York  an  act  was  passed  May  19,  1908, 
making  it  the  duty  of  every  physician  to  report  to  the  local  health  officer  every 
case  of  tuberculosis  known  to  him  within  24  hours  after  this  fact  comes  to  his 
knowledge,  every  officer  in  charge  of  any  hospital,  dispensary,  asylum,  or  other 
similar  private  or  public  institution  being  required  to  report  likewise  every 
patient  with  tubercutosis  24  hours  after  coming  into  his  care  or  under  his 
observation.  Upon  receipt  of  such  information  the  health  officer  is  to  provide 
the  physician  with  a  printed  form  naming  the  procedures  and  precautions  neces- 
sary or  desirable  to  be  taken  on  the  premises  of  a  tuberculous  patient.  If 
these  instructions  are  not  carried  out  by  the  physician  this  duty  devolves  upon 
the  health  officer.  The  premises  left  vacant  by  the  removal  or  death  of  a 
person  suffering  with  tuberculosis  are  not  to  be  again  occupied  until  properly 
disinfected,  cleansed  or  renovated  according  to  directions  of  the  health  officer. 
The  physician  in  charge  of  the  case,  or  in  case  he  fails  to  do  so  the  local 
health  officer,  must  give  proper  instructions  regarding  safety  of  other  individ- 
uals occupying  the  same  house  or  apartment. 

Laws  similar  to  the  above  were  passed  in  1900  in  Kansas,  Maine,  Michigan, 
and  New  Jersey. 

Anti-spitting  laws  were  passed  in  1909  in  Kansas,  Maine,  Michigan,  and 
Pennsylvania. 

Laws  were  passed  in  1909  in  Illinois  and  Minnesota,  authorizing  the  estab- 
lishment and  maintenance  of  public  tuberculosis  sanatoria,  while  a  law  was 
passed  in  1908  in  Ohio  directing  the  construction  in  every  county  of  special 
hospitals  for  the  care  and  treatment  of  tuberculosis  patients. 

In  Vermont  a  law  was  passed  in  1908  directing  the  State  Board  of  Health 
to  conduct  a  campaign  of  education  regarding  the  best  known  methods  of 
preventing  and  limiting  the  spread  of  tuberculosis  by  modern  sanitary  pre- 
cautions. 


182  FOURTH    INTERNATIONAL  SANITARY   CONFERENCE. 

In  Michigan,  provision  was  made  by  law  for  the  teaching  in  public  schools 
of  the  principal  modes  by  which  each  of  the  dangerous  communicable  diseases 
are  spread,  and  the  best  methods  for  their  restriction  and  prevention. 

New  Jersey  made  provision  in  1909  for  the  employment  by  every  school 
board  of  one  medical  inspector,  or  more  if  necessary,  to  examine  every  pupil 
in  order  to  learn  whether  any  physical  defect  exists,  and  keep  a  record  of  the 
growth  and  development  of  each  pupil.  This  inspector  is  also  required  to 
instruct  the  teachers  as  to  the  methods  employed  to  detect  the  first  signs  of 
communicable  diseases  and  the  recognized  measures  for  the  promotion  of  health 
and  the  prevention  of  disease. 

In  Minnesota  legislation  was  passed  in  1909  providing  for  the  condemnation 
of  any  workshop,  factory  or  place  of  business  considered  unhealthy  or  un- 
suitable by  the  Commissioner  of  Labor. 

The  Territory  of  Arizona  limited  by  law  the  hours  of  labor  for  persons 
employed  in  laundries  to  48  in  a  week,  and  the  minimum  quantity  of  air  (600 
cubic  feet)  to  be  afforded  to  every  worker. 

Provision  was  made  for  the  application  of  the  tuberculin  test  to  cattle  in 
Kansas,  Minnesota,  and  Utah. 

Contagious  diseases. — Legislation  was  passed  in  the  States  of  Maine,  North 
Carolina  and  Vermont  providing  that  boards  of  health  should  furnish  diphtheria 
antitoxin  free  of  charge,  under  certain  conditions,  to  persons  suffering  from 
the  disease.  Iowa  and  Maine  also  made  provision  for  the  assistance  by  the 
local  board  of  health  of  any  indigent  person  or  family  placed  in  quarantine  on 
account  of  any  dangerous  or  contagious  disease. 

In  Kansas  the  State  Board  of  Health  was  charged  by  law  with  the  sanitary 
supervision  of  all  barber  shops,  barber  schools,  public  bath  houses,  and  was 
also  empowered  to  make  all  necessary  rules  and  regulations  in  order  to  prevent 
the  spread  of  contagious  and  infectious  diseases. 

In  Pennsylvania  legislation  was  passed  in  1909  requiring  every  physician 
to  report  all  cases  treated  by  them  of  certain  communicable  diseases,  the  health 
authorities  being  directed  to  quarantine  all  cases  of  contagious  diseases  such 
as  diphtheria,  measles,  chicken-pox,  smallpox,  malarial,  relapsing,  scarlet,  typhoid 
and  yellow  fevers,  plague,  cholera,  cerebro-spinal  meningitis,  and  to  specify  the 
manner  in  which  the  premises  occupied  by  persons  suffering  with  any  of  these 
diseases  are  to  be  disinfected  after  being  vacated. 

I  will  say,  also,  for  the  great  State  of  Pennsylvania  that  they  have  a  very 
good  law,  which  is  being  carried  out,  in  regard  to  reporting  cases  of  sickness 
and  acquiring  morbidity  statistics. 

In  Wyoming  a  law  was  enacted  in  1909  empowering  the  State  Board  of 
Health  to  prescribe  rules  and  regulations  for  the  management  and  control  of 
communicable  diesases,  such  rules  and  regulations  being  later  in  the  year 
issued  by  the  Board.  Similar  regulations  were  issued  in  Montana  by  the  State 
Board  of  Health  in  compliance  with  provisions  of  existing  laws. 

In  Texas  a  law  was  passed  providing  for  the  erection  of  a  horne  whereto 
all  persons  suffering  with  leprosy  will  be  removed  with  a  view  to  their  isolation, 
care  and  treatment,  and  making  it  unlawful  for  any  person  to  harbor  or 
conceal  lepers  within  the   State. 

Pure  Food  Laws. — Amendments  to  the  existing  laws  were  enacted  in  several 
States.  Maine  made  provision  for  the  proper  cleansing  and  sterilizing  of  all 
vessels  and  utensils  used  in  the  manufacture,  transportation,  storage  and  sale 
of  milk  and  cream  and  the  maintenance  of  sanitary  conditions  in  places  where 
milk  is  handled.  The  Commissioner  of  Agriculture  was  also  directed  to  inves- 
tigate the  processes  involved  in  the  production  and  sale  of  milk,  butter  and 
similar  products,  analyzing  samples  of  articles  and  publishing  the  results  of 
the  analyses  made,  all  milk  dealers  being  required  to  register  at  his  office.^ 

By  a  law  passed  in  1909  New  Jersey  requires  every  physician  attending  a 
person  sick  with  typhoid  fever,  dysentery,  scarlet  fever,  diphtheria  or  tuberculosis 
on  any  premises  where  milk  is  produced  for  sale,  or  distribution,  to  report 
the  case  to  the  State  Board  of  Health  within  12  hours  after  his  first  attend- 
ance upon  the  patient.  In  the  same  State  another  law  was  passed  in  the  same 
year  stating  the  sanitary  conditions  to  be  observed  in  all  places  where  food 
intended  for  sale,  or  distribution,  is  prepared,  and  prohibiting  the  employment 
on  such  places  of  any  person  affected  with  a  communicable  disease. 

Registration  of  Births  and  Deaths.— In  1909  laws  were  passed  in  Missouri 
and   in   Arizona  providing   for   the   immediate   registration   of   all   births   and 


FOURTH  INTERNATIONAL  SANITARY  CONFERENCE.  183 

deaths.     North  Carolina  provided  for  the  registration  of  deaths  in  municipalities 
of  1,000  population  and  over. 

Now,  that  is  a  brief  summary  in  regard  to  the  passage  of  law*  for  the  different 
States  of  the  United  States.  You  will  see  that  very  important  work  is  going  on 
in  the  several  States  and  the  work  of  education  in  public  health  matters  is  ad- 
vancing very  rapidly  throughout  the  States  and  municipalities  of  the  country. 

II.      REPORT  ON  MANNER  IN  WHICH  THE  RESOLUTIONS  ADOPTED  IN  PREVIOUS  SANITARY 

CONVENTIONS  OF  THE  AMERICAN   REPUBLICS   HAVE  BEEN   PUT  IN   PRACTICE 
IN  THE  UNITED   STATES. 

Now,  with  regard  to  certain  of  the  epidemic  diseases — special  diseases  with 
which  the  United  States  has  had  to  deal — I  beg  leave  to  report  that  all 
quarantine  laws  and  regulations  of  the  United  States  bearing  on  plague,  cholera, 
and  yellow  fever  conform  strictly  to  the  Convention  signed  at  Washington, 
October  14,  1905,  no  changes  having  been  made  in  them  during  the  last  two 
years. 

Yellow  Fever. — In  full  accordance  with  Section  II,  Chapter  I  of  this  Con- 
vention, and  on  account  of  the  continued  appearance  of  cases  of  yellow  fever 
in  various  parts  of  the  island  of  Cuba,  a  case  having  occurred  as  late  as 
February  18th,  quarantine  was  imposed  April  6,  1908,  upon  porta  in  the  island, 
with  the  exception  of  an  area  comprising  the  city  of  Habana,  Mariano  and 
Base  Camp  Columbia.  Subsequent  cases  occurred  in  Santiago  on  April  21st, 
May  13th,  June  4th  and  11th,  and  July  7th,  while  the  trend  of  facts  seemed  to 
indicate  that  the  disease  had  been  prevalent  at  Daiquiri  since  April,  and 
subsequent  reports  of  cases  went  to  prove  that  the  Province  of  Santiago  was 
infected  with  yellow  fever.  In  consequence  of  a  secondary  case  reported 
on  September  14th  from  a  district  of  Habana  where  mosquitoes  were 
abundant,  quarantine  restrictions  were  put  into  effect  against  departures  from 
Habana  for  Southern  ports  in  the  United  States.  These  measures  were  made 
as  lenient  as  consistent  with  public  safety.  There  were  no  obstacles  thrown 
in  the  way  of  immune  passengers  provided  they  presented  to  the  officer  of  the 
Public  Health  and  Marine  Hospital  Service  detailed  at  Habana  the  proofs  of 
their  immunity.  In  the  case  of  non-immune  passengers  they  were  detained 
in  the  camp  at  Triscomia,  in  the  harbor  of  Habana,  six  days  if  going  to  Florida, 
five  if  bound  for  other  Southern  ports.  The  restrictions  against  Habana  were 
removed  18  days  from  the  date  of  the  above-mentioned  case,  and  against 
the  other  ports  as  soon  as  satisfactory  evidence  of  sanitary  conditions  was 
obtained.  The  quarantine  was  raised  finally  from  Santiago  Province,  which 
was  the  last  area  under  suspicion  October  20,  1908,  from  which  date  no 
special  quarantine  measures  have  been  enforced  with  respect  to  Cuba.  All 
of  the  steps  in  this  transaction  were  taken  after  careful  consideration  of  the 
provision  in  Article  IX  of  the  Convention  of  Washington  with  regard  to 
yellow  fever  and  the  further  explanation  of  its  contents  by  the  Delegate  from 
Cuba   as   follows : 

"Now  we  have  added  here  the  provision  that  the  authorities  might  extend 
tliat  period  of  expectancy  or  waiting  before  declaring  a  place  free  from  yellow 
fever;  that  they  may  extend  it  ad  libitum,  because  we  have  considered  that  at 
certain  places  where  yellow  fever  regularly  prevails — that  is,  is  endemic — the 
number  of  immune  people  is  so  great  that  there  might  be  a  large  number,  or 
a  quite  considerable  number,  of  mosquitoes  lurking  in  that  locality  without 
invoking  yellow  fever  because  of  the  immunity  of  the  inhabitants,  and  we 
might  be  surprised  at  any  time  by  a  case  of  5'ellow  fever.  We  have,  therefore, 
allowed  this  freedom  to  the  authorities  to  extend  this  period — to  extend  it  the 
whole  length  of  the  yellow-fever  season,  or  the  whole  summer  if  they  desire. 
At  any  rate,  we  have  given  them  the  fredom  to  extend  this  period." 

For  the  purpose  of  supervising  the  sanitation  of  ships  bound  for  the  United 
States  eight  officers  of  the  Public  Health  and  Marine  Hospital  Service  have 
been  stationed  at  fruit  ports  in  Central  America  and  the  West  Indies,  thus 
making  possible  the  entry  of  fruit  vessels  to  the  United  States  without  deten- 
tion at  quarantine  stations.  It  is  pleasant  to  note  the  decrease  of  yellow  fever 
in  the  last  two  years,  no  cases  having  occurred  in  the  United  States,  these 
results  being  undoubtedly  due  to  the  greater  attention  paid  to  sanitary  matters 
at  ports,  the  close  observance  of  quarantine  regulations,  and  the  great  activity 
also  of  sanitary  authorities  in  Mexico,  Brazil,  Canal  Zone,  and  Cuba. 


184  FOURTH   INTERNATIONAL  SANITARY   CONFERENCE. 

I  will  say  that  it  must  have  been  a  matter  of  great  gratification  to  those 
members  who  are  here  in  this  Convention  that  the  last  season  has  been  spe- 
cially marked  by  the  absence  of  yellow  fever  in  all  of  our  territories.  I  think 
the  season  of  1909 — summer  and  fall  of  1909 — has  been  a  remarkable  one 
and  one  upon  which  we  can  all  look  with  special  gratification,  because  it  does 
seem  as  if  we  were  conquering  this  dread  disease  of  yellow  fever.  If  you  will 
cast  your  eyes  over  the  different  parts  of  the  Western  Hemisphere,  mentally, 
where  yellow  fever  has  been  in  the  habit  of  prevailing,  you  will  find  that  it  has 
not  prevailed  in  any  of  those  places  during  the  past  season,  at  any  rate  in  an 
epidemic  form,  with  perhaps  one  possible  exception,  but  the  exception  is  enough 
to  call  attention  to  the  general  fact. 

Cholera. — The  presence  of  cholera  in  Russia  in  1908  and  the  fear  of  its  intro- 
duction in  the  United  States  on  account  of  the  considerable  immigrant  traffic 
from  that  country  caused  the  Public  Health  and  Marine  Hospital  Service  to 
station  one  of  its  officers  at  Libau,  the  only  port  from  which  vessels  carrying 
immigrants  sail  direct  for  the  United  States.  The  outbreak  of  cholera  which 
occurred  in  Rotterdam,  Holland,  August  26,  1909,  also  caused  the  detail  of 
an  officer  to  that  place  to  investigate  conditions.  The  outbreak  terminated, 
however,  on  September  11th,  there  being  13  cases  and  5  deaths.  In  the  Philip- 
pines, in  the  fiscal  year  ending  June  30,  1909,  there  were  23,094  cases  of  cholera, 
of  which  981  cases  occurred  in  the  city  of  Manila.  The  precautions  taken 
and  the  vigilance  of  quarantine  officers  at  home  ports  were  effective  in  each 
of  these  cases  in  preventing  the  entrance  of  cholera  in  the  United  States, 
and  the  prevention  of  its  spread  to  other  ports,  both  domestic  and  foreign. 

Plague. — The  measures  mentioned  in  the  report  of  the  Delegates  of  the 
United  States  to  our  last  Convention  for  the  eradication  of  plague  on  the 
Pacific  Coast  were  continued  by  the  Public  Health  and  Marine  Hospital  Service. 
No  cases  of  human  plague  occurred  at  San  Francisco  after  February,  1908, 
no  cases  at  Oakland  after  July  17,  1908,  and  the  last  case  of  rat  plague  found 
was  on  October  23,  1908,  at  San  Francisco,  and  on  December  1,  1908,  at 
Oakland.     At  Seattle    no  case  of  human  plague  has  occurred  after  October  25, 

1907,  and   no   case    of   rat   plague    after    September   26,    1908.     On   January  22, 

1908,  conditions  had  improved  to  such  an  extent  at  Seattle  to  justify  the 
Public  Health  and  Marine  Hospital  Service  in  turning  over  the  municipal 
inspection  and  policing  to  the  special  sanitation  department  of  the  city  to  be 
carried  on  under  principles  suggested  by  the  Service,  the  pathological  and 
bacteriological  work,  including  the  examination  of  rats  sent  to  the  laboratory 
to  be  continued,  however,  by  officers  of  the  Service.  As  stated  in  the  _  last 
report,  the  measures  taken  consisted  chiefly  in  the  improvement  of  sanitary 
conditions  and  the  destruction  of  rats.  Some  practical  results  of  the  campaign 
of  education  carried  on  systematically  were  the  installation  of  garbage  cans 
in  practically  every  home  in  San  Francisco  and  Seattle  in  order  to  facilitate  the 
disposal  of  refuse,  the  rebuilding  of  stables  in  San  Farncisco  with  a  view  to 
making  them  rat-proof,  and  the  provision  made  by  the  supervisors  of  the  city 
for  the  complete  rearrangement  and  reconstruction  of  the  sewer  system  and 
the  installation  of  sewers  in  districts  lacking  that  service.  The  total  number 
of  rats  exterminated  at  San  Francisco  and  Oakland  from  the  date  of  the 
outbreak  of  plague  to  June  30,  1909,  may  be  roughtly  estimated  at  more  than 
one  million.  Of  this  number  423,346  were  caught  and  200,871  examined. 
During  the  same  period  92,750  rats  were  caught  at  Seattle,  and  89,652  examined. 

One  of  the  most  important  duties  devolving  upon  the  Public  Health  and 
Marine  Hospital  Service  in  connection  with  the  epidemic  was  the  thorough 
fumigation  of  vessels  leaving  San  Francisco  and  Seattle  in  order  to  prevent  the 
spread  of  infection  to  other  places.  Up  to  June  30,  1908,  2,796  vessels  were 
disinfected  at  San  Francisco  and  145  at  Seattle,  this  work  being  so  eflfective 
and  far-reaching  that  there  is  not  a  single  record  of  a  case  of  plague  traceable 
to  either  San  Francisco  or  Seattle  having  occurred  in  any  one  of  the  many 
cities  connected  by  sea  with  these  two  places. 

The  important  discovery  that  ground  squirrels  can  be  infected  with  plague 
was  made  soon  after  the  mitigation  of  the  epidemic  at  San  Francisco  when 
when  a  boy  bitten  by  a  sick  squirrel  at  Los  Angeles,  Cal.,  developed  symptoms 
of  plague.  Of  423  ground  squirrels  from  Contra  Costa  County,  Cal.,  which 
were  the  subject  of  laboratory  investigation,  four  gave  positive  evidence  of 
plague  infection.  About  May  1,  1909,  an  organized  campaign  was  inaugurated 
by  the  Service  for  the  destruction  of  these  animals.     This  work  will  have  to  be 


FOURTH  INTERNATIONAL  SANITARY  CONFERENCE.  185 

continued  for  an  indefinite  period  owing  to  the  habits  of  these  animals  and 
their  wide  distribution.  Up  to  October  30,  1909,  44,843  squirrels  had  been 
destroyed,  out  of  which  number  298  were  found  to  be  infected.  And  we  have 
been  continuing  and  are  still  continuing  a  warfare  against  ground  squirrels 
in  the  counties  of  California,  and  we  find  them  infected.  We  are  examining 
all  of  them. 

In  order  to  prevent  the  further  importation  of  plague  and  avoid  all  inter- 
ruption of  commerce  with  these  sister  Republics  officers  of  the  Public  Health 
and  Marine  Hospital  Service  have  been  detailed  to  Guayaquil,  Callao,  Rio 
Janeiro  and  La  Guayra,  with  special  instructions  given  to  observe  a  close 
surveillance  on  ships  bound  for  the  United  States  and  cause  the  destruction 
of  rats  found  aboard.  By  request  of  the  Venezuelan  authorities  an  officer  of 
the  Service  was  permanently  stationed  at  La  Guayra  and  provided  with  the 
laboratory  equipment  necessary  for  a  prompt  diagnosis  of  the  disease. 

Now,  I  will  not  detain  you  longer  by  reading  all  that  I  have  prepared,  but 
I  will  only  mention  three  or  four  special  diseases  of  great  special  interest 
in  the  United  States  during  the  last  year  or  two. 

One  is  pellagra,  a  disease  which  I  find,  Mr.  President,  is  unknown  here, 
but  it  is  very  common  in  certain  parts  of  Europe,  particularly  in  Italy,  and 
which  we  find  to  exist  in  the  United  States.  The  great  fear  is  that  it  may 
become  habitual  to  the  United  States,  so  to  speak,  just  as  it  has  become  in 
Italy,  and  we  are  making  earnest  war  against  the  disease  and  taking  preventive 
measures  to  prevent  its  getting  a  foothold  and  the  consequent  death  and 
misery  which  it  produces.  A  scientific  commission  for  the  purpose  has  been 
appointed'  and  they  are  now  at  work  upon  it. 

Another  disease  of  very  great  interest  is  the  hookworm  disease,  which  I 
believe  you  do  have  in  this  country;  and  I  take  pleasure  in  calling  attention 
to  the  great  gift  of  Mr.  Rockefeller  of  one  million  of  dollars  to  assist  in  the 
eradication  of  the  hookworm  disease  in  the  South.  He  has  given  this  money, 
not  establishing  a  fund  the  interest  of  which  shall  be  devoted  to  this  special 
work,  but  he  has  given  the  fund  outright,  and  it  is  expected  that  $200,0(X) 
will  be  expended  every  year  until  the  whole  amount  is  expended.  The  method 
of  using  that  fund  at  the  time  I  left  the  United  States  was  still  a  matter  for 
consideration  and  had  not  yet  been  fully  determined  upon.  Dr.  Stiles,  who  has 
particularly  devoted  himself  to  the  hookworm  disease,  is  on  the  Commission. 
He  is  the  medical  zoologist  of  the  Public  Health  and  Marine  Hospital  Service, 
and  will  lend  himself  without  doubt  earnestly  to  the  work  of  eradication  of 
hookworm  disease. 

I  have  here  some  pamphlets  with  the  regard  to  the  hookworm  disease,  as 
well  as  with  regard  to  pellagra,  which  I  will  just  pass  around  for  observation. 

Now,  Mr.  President,  I  feel  that  I  have  taken  up  all  the  time  allotted  to  me, 
and  it  will  not  be  necessary  at  this  time  to  state  all  that  has  been  done  in 
detail.  I  have  already  mentioned  the  more  important  of  the  recent  laws  of  the 
different  States  with  regard  to  these  diseases,  reporting,  and  the  measures  for  the 
prevention  of  the  spread  of  pellagra,  hookworm  disease,  tuberculosis  and  typhoid 
fever,  that  is,  the  principal  diseases  which  have  received  the  attention  of  the 
States  and  National  Government  during  the  last  year. 

It  is  a  great  pleasure  to  think  that  we  need  not  devote  our  attention,  as  we 
were  formerly  compelled  to,  to  the  ordinary  contagious  diseases,  such  as 
smallpox,  cholera,  and  even  the  bubonic  plague.  Those  diseases  are  now  prac- 
tically understood  as  regards  their  nature  and  methods  of  dealing  with  them, 
and  we,  in  the  United  States,  are  devoting  greater  attention  and  more  thought 
and  study  to  the  other  diseases  such  as  I  have  just  mentioned.     (.A.pplause.) 


SOME   PRE.SENT    PUBLIC    HEALTH    PROBLEMS    IN    THE    UNITED    ST.\TES. 
PELLAGRA. 

This  disease,  which  has  prevailed  in  Southern  Europe  for  more  than  a 
century,  is  now  attracting  widespread  attention  in  the  United  States,  following 
the  appearance  of  a  considerable  number  of  cases  in  different  parts  of  the 
country. 

The  occurrence  of  pellagra  was  first  reported  in  Alabama  m  May,  1907,  only 
sporadic  cases  having  been  reported  before  that  date,  one  of  them  from  Georgia 


186  FOURTH    INTERNATIONAL  SANITARY   CXDNFERENCE. 

as  early  as  190Z  When  the  first  cases  of  the  disease  were  reported  from 
Alabama,  where  it  assumed  the  character  of  an  epidemic  at  the  time,  an  officer 
of  the  JPublic  Health  and  Marine  Hospital  Service,  who  had  had  extensive 
service  in  Italy,  invited  attention  to  the  importance  of  the  subject  in  relation 
to  the  public  health,  and  recommended  that  investigations  be  undertaken.  As 
a  result,  the  Surgeon-General  called  for  and  received  a  report  upon  the  disease 
with  particular  reference  to  its  prevalence  in  Alabama. 

Subsequently,  reports  of  the  occurrence  of  pellagra  in  other  States  began 
to  appear,  an<l  it  became  evident  from  the  studies  made  that  the  new  disease 
was  a  matter  of  serious  concern  for  the  United  States.  While  pellagra  was 
at  first  reported  only  from  the  Southern  States,  reports  subsequently  received 
showed  the  existence  of  the  disease  in  no  less  than  18  States. 

In  the  summer  of  1908  a  precis  on  pellagra  by  an  officer  of  the  Public  Health 
and  Marine  Hospital  Service  was  published  and  distributed  for  the  use  of 
health  officials.  Following  the  appearance  of  this  publication,  considerable 
interest  in  the  new  disease  was  evinced  by  medical  practitioners  and  laymen 
in  the  localities  affected,  the  health  authorities  having  recognized  from  the 
beginning  the  importance  of  the  health  problem  that  had  appeared.  Sys- 
tematic investigations  of  the  disease  in  its  clinical,  epidemiological,  pathological, 
bacteriological  and  therapeutic  aspects  have  been  conducted  by  the  Public 
Health  and  Marine  Hospital  Service  during  the  years  1908  and  1909.  In  order 
to  enlarge  the  scope  of  the  investigations,  a  pellagra  commission  was  appointed 
consisting  of  seven  .scientific  workers,  who  will  devote  their  best  energies  to 
different  phases  of  the  problem  with  the  view  to  their  elucidation. 

Knowledge  of  the  disease  indicates  that  it  is  not  communicable  and  that  it 
is  in  some  indefinite  manner  associated  with  the  consumption  of  diseased 
corn.  This  latter  probability  has  an  important  bearing  both  from  the  stand- 
point of  the  public  health  and  economic  interests,  and  the  Bureau  of  Plant 
Industry  of  the  United  States  Department  of  Agriculture  has  undertaken  an 
investigation  of  corn  with  a  view  to  determining  its  possible  relation  to  the 
development  of  pellagra. 

On  account  of  lack  of  knowledge  of  pellagra  and  because  of  its  increasing 
prevalence,  fear  of  the  disease  has  been  engendered  in  certain  localities,  giving 
rise  to  the  demand  for  segregation  of  those  afflicted.  In  the  absence  of  evidence 
that  communicability  plays  a  part  in  the  continued  prevalence  of  the  disease, 
however,  it  has  not  been  deemed  advisable  or  necessary  by  the  National 
Government  to   institute  quarantine  procedures. 

The  presence  of  pellagra  in  any  country  must  be  regarded  as  a  public 
health  problem  of  national  consequence.  This  does  not  mean,  however,  that 
there  is  cause  for  panic,  but  it  should  stimulate  interest  in  the  disease  which 
would  resolve  itself  into  reasonable  prophylaxis  and  improved  sanitation. 

TUBERCXJLOSIS. 

The  United  States  has  done  and  is  now  doing  its  share  in  the  world- 
wide campaign  waged  against  this  disease.  The  great  interest  taken  in  this 
subject  was  demonstrated  in  the  success  attending  the  International  Tuber- 
culosis Congress,  held  in  Washington,  D.  C.,  in  October,  1908,  under  the 
auspices  of  the  United  States  Government.  Its  deliberations  were  undoubtedly 
very  valuable,  opportunities  being  given  to  all  the  delegates  for  a  full  dis- 
cussion of  modern  scientific  ideas  as  to  the  methods  of  dealing  with  tuber- 
culosis. The  organization  of  the  Congress  included  seven  sections,  Section  VI 
being  devoted  to  the  consideration  of  State  and  municipal  control  of  tuberculosis. 
Its  meetings  covered  practically  all  phases  of  the  subject,  and  there  is  no 
doubt  that  it  had  a  great  influence  in  calling  the  attention  of  the  public  to 
modem  methods  of  dealing  with  tuberculosis  and  paving  the  way  for  sanitary 
legislation   and  its  enforcement  in   the   future. 

Good  work  is  being  continuously  done  by  both  private  and  official  initiative 
for  the  study  and  prevention  of  tuberculosis.  The  considerable  and  important 
legislation  on  the  subject  enacted  by  the  several  States  is  reviewed  elsewhere. 
It  is  pleasant  to  note  that  State  associations  are  rapidly  being  formed  to  check 
the  progress  of  the  disease,  and  the  results  already  obtained  may  be  appre- 
ciated from  the  fact  that  the  death  rate  per  100,000  of  estimated  population 
credited  to  tuberculosis,  which  was  as  high  as  183.6  in  1907  fell  to  173.9  in 
1908.     The  most  effective  means  of  education  yet  devised  have  been  found  to 


FOURTH  INTERNATIONAL  SANITARY  CONFERENCE.  187 

be    free   exhibitions   in    combination    with    which    demonstrations    and   popular 
lectures   are  given   and  literature   is   distributed. 

The  problem  of  tuberculosis  among  colored  people  is  one  of  serious  import- 
ance, this  disease  causing  nearly  four  times  as  many  deaths  among  that 
race  as  among  white  people.  An  officer  of  the  Public  Health  and  Marine 
Hospital  Service,  lecturing  before  a  negro  farmers'  conference  last  March, 
suggested  that  colored  anti-tuberculosis  leagues  be  organized  in  the  States,  and 
outlined  a  working  plan  for  such  leagues.  The  suggestion  was  received  with 
favor  and  heartily  endorsed  at  the  conference  of  State  and  Territorial  health 
officers  held  at  Washington  in  1909.  At  this  time  five  leagues  with  branches 
in  colored  churches  had  been  organized  in  different  States.  This  plan,  it 
is  believed,  will  aid  health  authorities  in  the  campaign  against  tuberculosis,  and 
beneficial  results  may  be  expected  from  such  co-operation.  It  provides  for 
the  rendering  of  financial  aid  by  the  negroes  themselves  to  those  of  their 
own  race  who  are  afflicted  with  the  disease,  and  its  educational  features  must 
of  necessity  cause  an  improvement  in  the  conditions  under  which  the  negro  lives. 


Ill  AND  V.      ABSTRACTS  OF  REPORTS  IN  REGARD  TO  SANITARY  CONDITIONS  IN  AMERICAN 
PORTS   (prepared  BY  OFFICERS  OF  THE  PUBUC  HEALTH  AND    MARINE  HOS- 
PITAL SERVICE  ON  INFORMATION  FURNISHED  BY  LOCAL  AUTHORITIES)  . 


New  Orleans,  La. 

water  supply. 

The  Sewerage  and  Water  Board  has  now  in  operation  a  purification  plant 
with  a  capacity  for  about  40,000,000  gallons  of  water  per  day,  and  house  con- 
nections are  being  made  as  rapidly  as  possible.  When  the  connecting  work  is 
completed,  it  is  intended  to  abolish  the  use  of  cisterns,  experience  having  shown 
that  they  serve  as  breeding  places  for  mosquitoes  unless  carefully  screened. 

SEWERAGE. 

The  above-mentioned  Board  has  also  completed  325  miles  of  sewers,  and  is 
approaching  the  termination  of  its  task,  only  fifty  miles  of  sewers  remaining 
to  be  built. 

DRAINAGE. 

Seven  huge  drainage  pumps  lift  the  water  from  drainage  canals  over  the 
protection  levees  at  the  rear  of  the  city  and  discharge  into  the  lakes  and 
bayous.  Sixty  per  cent  of  all  the  proposed  canals  and  conduits  are  in  opera- 
tion, and  as  this  work  advances  the  old  time  common  event  of  a  flooded 
city  becomes  more  and  more  rare. 

PAVEMENT. 

Extensive  additions  to  the  paved  area  are  continuously  being  made,  but  a 
general  system  cannot  be  adopted  until  the  entire  completion  of  the  drainage, 
sewerage  and  water  works  now  under  construction. 

MOSQUITO   DESTRUCTION. 

Under  the  provisions  of  Municipal  Ordinance  of  September  27,  1905,  an 
active  anti-mosquito  campaign  is  carried  on  under  the  direction  of  the  local 
board  of  health  from  February  1st  to  November  30th.  A  special  body  of 
men  is  in  charge  of  this  work,  which  consists  chiefly  of  three  general  in- 
spections with  a  view  to  finding  out  and  remedying  defective  conditions 
throughout  the  city.  

Philadelphia,  Pa. 

The  death  rate  for  the  year  1908  was  the  lowest  ever  known  in  the  city. 
The  typhoid  fever  mortality  was  especially  low,  this  decrease  being  due  largely 


188  FOURTH   INTERNATIONAL  SANITARY   CONFERENCE. 

to  the  filtration  plants  which  have  been  gradually  installed  during  the  last 
few  years.  The  last  plant  was  put  into  operation  during  the  present  year,  so 
that  the  whole  city  is  now  supplied  with  filtered  water.  Sixty-five  per  cent 
of  the  water  supply  is  obtained  from  the  Delaware  River  and  the  remainder 
from  the  Schuylkill  River.  It  is  claimed  that  the  filtration  plants  of  the 
city  are  taking  out  nearly  100  per  cent  of  bacteria.  The  records  for  previous 
years,  when  the  city  was  only  partially  provided  with  filtration  plants,  show 
that  there  were  6J/2  cases  of  typhoid  fever  in  the  filtration  districts  to  100 
cases  in  the  non-filtration  districts,  a  reduction  as  compared  with  the  previous 
years  of  about  80  per  cent  where  filtered  water  was  used.  The  reduction  in 
the  number  of  typhoid  fever  cases  is  also  partly  due  to  the  fact  that  physicians 
are  required  to  immediately  report  all  cases  of  this  disease  to  the  Department 
of  Health  as  soon  as  the  diagnosis  is  made,  and  inspectors  are  sent  to  trace 
the  source  of  infection  and  to  see  that  precautions  are  taken  to  prevent  the 
spread  of  the  disease. 

The  city  government  now  has  thirty  beds  for  advanced  cases  of  tuberculosis 
for  females,  and  100  beds  for  males  at  the  Philadelphia  General  Hospital. 
The  city  has  also  erected  a  sanitorium  with  a  capacity  of  100  beds,  and  an 
infirmary  with  a  capacity  for  30  patients,  both  for  males.  Tuberculosis  patients 
may  also  be  sent  to  the  sanatoria  erected  by  the  State  in  accordance  with  laws 
approved  in  1905  and  1907. 

The  sewage  of  Philadelphia  is  at  present  discharged  into  the  neighboring 
rivers.  Experiments  are  now  being  made  with  a  view  to  disposing  of  it  in 
some  other  way,  but  no  plan  has  as  yet  been  decided  upon.  An  Act  of  the 
Legislature,  passed  in  1907,  to  go  into  effect  in  1912,  compels  all  cities  in  the 
State  to  erect  plants  for  the  disposal  of  their  sewage. 


Baltimore,  Md. 

The  death  rate  for  the  past  six  years  has  shown  a  steady  decrease,  falling 
from  an  annual  rate  of  20  per  thousand  in  1904  to  18.21  per  thousand  in 
1908.  The  figures  for  the  present  year  are,  of  course,  not  available,  but  the 
indications  are  for  a  further  drop. 


WATER    SUPPLY. 

The  city's  water  supply  is  obtained  from  the  Gunpowder  River  and  Jones* 
Falls  (surface  water).  This  is  now  considered  to  be  insufficient,  and  the  city 
is  expecting  to  begin  at  an  early  date  the  construction  of  works  that  will 
increase  it.     A  slow  sand  filter  will  probably  be  constructed  at  the  same  time. 

SEWERAGE. 

The  city  is  now  about  completing  the  expenditure  of  a  ten-million-dollar 
loan  for  the  construction  of  the  sanitary  sewerage  system.  A  small  part  of 
this  money  has  been  used  in  constructing  the  necessary  storm  water  sewers. 
Contracts  have  been  let  for  the  construction  of  the  outfall  (this  will  consist 
of  a  septic  tank  and  sprinkling  filter  beds)  and  the  pumping  station,  which 
will  connect  the  low  and  high  service  sewers.  The  low  incepting  sewer  has 
already  been  constructed,  and  in  the  eastern  section  of  the  city  many  of  the 
laterals  have  been  completed  and  will  be  ready  for  use  as  soon  as  the  pumping 
station  and  the   outfall  are  completed. 


Seattle. 


DEPARTMENT    OF    HEALTH. 


The  reorganization  of  the  Department  of  Health  and  Sanitation  was  accom- 
plished in  March,  1908,  when  advantage  was  taken  of  the  more  recent  advances 
in  municipal  sanitation  to  establish  a  department  that  ranks  with  the  best 
in  the  United  States.  The  drop  in  the  death  rate  from  9.27  in  1907  to  7.35 
in  1908  is  claimed  to  be  due  to  the  sanitary  campaign  begun  in  the  fall  of 
1907  and  continued  to  this  day. 


FOURTH  INTERNATIONAL  SANITARY  CONFERENCE.  189 

SCHOOL    INSPECTION. 

A  system  of  medical  inspection  of  the  pupils  has  been  established  by  the 
Health  Department.  Ten  physicians  and  three  nurses  conduct  the  inspection, 
each  school  being  visited  once  a  week.  A  physical  record  of  each  child  is 
kept  on  a  card  from  his  entrance  to  school  until  he  graduates  or  leaves.  Chil- 
dren with  contagious  diseases  are  excluded  from  school  and  readmitted  only 
on  permission  of  the  medical  inspector.  Vaccination  is  a  compulsory  condi- 
tion of  entrance  to  school.  Physical  defects  or  other  diseases  than  contagious 
ones  are  noted  and  a  card  sent  to  the  parent  or  guardian  calling  attention  to 
the  child's  condition,  and  if  treatment  is  instituted  a  return  card  is  filled  out 
by  the  attending  physician. 

SANITARY  INSPECTION. 

The  chief  sanitary  engineer  has  charge  of  the  sanitary  inspectors,  market, 
milk,  meat  and  plumbing  inspectors,  watershed  patrol  and  the  rat  trappers 
and  poisoners. 

A  house  to  house  canvass  is  made  by  the  sanitary  inspectors  who  report 
upon  every  feature  of  the  sanitary  arrangement  and  condition  of  each  house, 
such  as  drainage,  sewerage,  plumbing,  ventilation  and  storage  and  disposal 
of  garbage  and  rubbish.  The  abatement  of  nuisances  is  effected  by  verbal 
or  written  notice,  and  by  prosecuting  the  owner  or  ordering  the  premises 
vacated  if  the  notice  is  disregarded.  Permits  for  the  construction  and  repair 
of  plumbing  are  issued  by  the  sanitary  department.  A  plumbing  inspector 
makes  a  preliminary  inspection  when  the  plumbing  has  been  roughed  in,  and 
a  final  inspection  upon  the  completion  of  the  work. 

WATER    SUPPLY. 

The  water  supply  of  the  city  of  Seattle  is  from  the  Cedar  River,  the  source 
of  which  is  at  an  approximate  elevation  of  six  thousand  feet  above  city 
in  the  Cascade  Mountains  to  the  southeast  of  Seattle.  The  water  is  brought 
about  twenty-eight  miles  to  the  city  bj'  gravity  through  wood-stave  pipes. 
There  are  in  service  about  four  hundred  miles  of  water  mains  which  serve 
about  Zl  per  cent  of  the  city.  It  is  expected  to  extend  this  service  to  the 
entire  city  during  the  coming  year. 

The  watershed  from  which  this  supply  is  obtained  contains  about  140  square 
miles.  The  city  has  acquired  title  to  about  twelve  square  miles  and  eighty-two 
square  miles  are  under  condemnation  proceedings.  This  will  give  the  city 
practical  control  of  the  watershed  as  the  balance  of  the  land  is  for  the  most 
part  either  incapable  of  improvement  or  in  the  Government  reserve.  The 
policing  of  this  section  is  in  charge  of  the  city  health  department  and  inspectors 
patrol  the  course  of  the  river  with  a  view  to  the  prevention  of  pollution  of 
the  city's  water  supply. 

DISPOSAL   OF    WASTE. 

The  city  of  Seattle  produces  about  200  tons  of  waste  daily,  including  ashes, 
manure,  rubbish,  table  refuse,  etc.  The  ultimate  disposal  of  this  waste  is 
a  problem  not  as  yet  solved  by  the  municipality.  The  waste  is  collected  by 
private  wagons,  licensed  by  the  city,  the  householder  paying  a  weekly  sum 
for  the  service. 

In  December,  1907,  the  city  completed  the  erection  of  a  garbage  incinerator 
of  the  Meldrum  type  at  a  total  cost,  exclusive  of  grounds,  of  $36,134.50.  This 
incinerator  has  a  rated  capacity  of  67  tons  of  2,000  pounds  for  twenty-four 
hours,  and  uses  no  fuel  other  than  that  contained  in  the  refuse.  During  the 
past  year  this  incinerator  has  burned  on  an  average  70  tons  daily,  at  an  average 
cost  of  fifty  cents  per  ton.  Of  the  remainder  of  the  city's  waste  it  is  estimated 
that  about  70  tons  is  dumped  on  the  tide  flats  and  burned  in  the  open,  and 
the  balance  disposed  of  by  private  burning,  dumping  into  Puget  Sound  or  on 
vacant   lots. 

SEWAGE   DISPOSAL. 

The  sewerage  system  of  the  city  of  Seattle  is  known  as  the  "combined 
gravity  system."  That  is,  one  line  of  sewer  pipe  is  laid  in  street  or  alley, 
to  receive  both  drainage  from  private  premises  and  from  the  streets,  and 
flows  by  gravity  to  its  outlet,  which  is  in  deep  water  in  Puget  Sound,  far  enough 


190  FOURTH    INTERNATIONAL   SANITARY   CONFERENCE. 

from  shore  so  as  not  to  create  a  nuisance  at  the  shore  line.     This  system  has 
proven  very  satisfactory. 

The  city  of  Seattle  has  an  area  of  about  sixty  square  miles,  of  which  about 
twenty-two  and  one-half  per  cent  is  being  served  by  sewers.  There  are  245 
mijes  of  sewers  in  the  cit\'.  When  a  sewer  has  been  laid  in  any  street  or  alley 
and  accepted  by  the  city,  it  becomes  incumbent  upon  all  abutting  property  to 
connect  therewith,  as  provided  by  city  ordinance.  Where  there  is  city  water 
service,  but  no  sewer  near  enough  for  direct  connection,  owners  are  required 
to  install  proper  cesspool  or  septic  tank  to  receive  the  waste  matter  from 
their  houses.  In  parts  of  the  city  where  there  is  no  water  service  vault 
toilets  are  allowed. 

Boston,  Mass. 
water  supply. 

Water  is  procured  from  three  sources,  Lake  Cochituate,  Sudbury  River,  and 
the  south  branch  of  Nashua  River.  The  metropolitan  water  system  consists 
of  a  series  of  reservoirs,  aqueducts  and  distributing  station,  supplying  eighteen 
mimicipalities  in  the  vicinity  of  Boston.  About  25,000,000  gallons  are  supplied 
daily.  There  is  no  filtration  plant  for  the  general  supply,  but  water  obtained 
from  some  portions  of  the  watershed,  especially  liable  to  pollution,  is  filtered 
before  being  admitted  to  the  reservoirs.  A  sanitary  inspection  of  the  water- 
shed  and  reservoirs   is   maintained  to   guard   against   sources   of  pollution. 


The  sewage  disposal  is  accomplished  by  an  elaborate  and  extensive  system 
of  engineering  works  consisting  of  main  and  intercepting  sewers,  tunnels, 
siphons,  pumping  stations,  reservoirs  and  outfall  sewers.  Briefly  stated,  the 
sewage  is  screened,  pumped  into  deposit  sewers,  conveyed  to  reservoirs  and 
discharged  into  outfall  sewers  at  the  entrance  of  Boston  Harbor.  The  sewage 
is  stored  in  the  reservoirs  during  flood  tide  and  the  latter  part  of  the  ebb 
tide,  and  is  discharged  during  the  first  two  hours  of  the  ebb  tide.  The  outfall 
sewers  discharge  sewage  at  points  approximately  five  miles  from  the  water 
front  of  the  city.  The  sludge  from  the  deposit  sewers  is  collected  periodically, 
placed  in  scows  and  towed  to  sea. 

Savannah,  Ga. 

The  death  rate  for  the  year  1908  was  the  lowest  in  the  history  of  the  city. 

In  the  year  1908  a  laboratory  was  established  for  bacteriological,  chemical 
and  pathological  work  and  the  study  of  problems  of  sanitary  science.  This 
institution  places  at  the  disposal  of  local  phj'sicians  free  of  charge  the  following 
opportunities : 

Examinations  of  the  throat  for  diphtheria  cultures. 

Examinations  of  the  blood  for  malarial  parasites,  and  for  the  Widal  reaction 
in  cases  of  suspected  typhoid  fever. 

Examinations  of  sputum  for  tubercle  bacilli. 

Examinations  of  dogs  for  rabies. 

Examinations  of  feces  for  ova  of  hookworm. 

Special  examinations  of  water,  ice,  milk  and  food  used  in  the  city. 


IV.      REPORT  RELATIVE  TO  THE  REGISTRATION   OF  THE   MOVEMENT  OF  POPULATION   AND 

THE  RATE  OF   MORTALITY   IN   THE  UNITED   STATES   DURING   THE   YEAR 

1908.       (compiled    CHIEFLY    FROM     DATA     APPEARING    IN 

CENSUS    BULLETIN    NO.    104,    1909.) 

The  registration  area  of  the  United  States  for  which  data  are  available  for  the 
year  1908  comprises  only  those  States  and  separate  cities  having  registration  of 
deaths  based  upon  the  requirement  of  compulsory  burial  permits.  Seventeen 
States,  namely:  California,  Colorado,  Connecticut,  Indiana,  Maine,  Maryland, 
Massachusetts,  Michigan,  New  Hampshire,  New  Jersey,  New  York,  Pennsyl- 
vania, Rhode  Island,  South  Dakota,  Vermont,  Washington,  Wisconsin,  the 
District  of  Columbia,  and  74  cities  in  non-registration  States  make  up  this  area 
whose  total  population  was  estimated  at  45,000,000,  or  over  one-half  of  the  total 


FOURTH  INTERNATTONAL  SANITARY  CONFERENCE. 


191 


estimated  population  of  the  United  States  proper.  The  total  number  of  deaths 
returned  for  the  year  was  691,574,  a  rate  of  15.4  per  1,000  of  estimated  popula- 
tion. The  year  was  one  of  remarkably  low  mortality,  being  marked  by  a  general 
absence  of  severe  epidemics  and  unusual  mortality  from  other  causes,  the 
death  rate  being  in  fact  the  lowest  ever  occurring  in  the  United  States. 

The  proportional  mortality  among  females  was  slightly  larger  than  in  1907, 
while  the  actual  number  of  deaths  of  males  was  less  than  for  1907.  The  per- 
centage of  deaths  of  infants  under  one  year  was  somewhat  increased,  but  the 
ratios  for  infants  from  one  to  four  were  practically  identical  with  those  of 
1907.  The  subsequent  quinquennial  periods  show  a  close  agreement,  the  dis- 
tribution being  slightly  more  favorable  for  the  year  1908  for  the  ages  15  to 
49  years.  About  one-fifth  of  all  deaths  were  of  infants  under  one  year,  and 
over  one-fourth  (nearly  200/XX)  deaths)  of  children  less  than  five  years.  It 
is  well  known  that  the  general  death  rate  of  a  country  is  largely  dependent 
upon  its  infant  mortality,  the  death  rates  of  infants  and  young  children  being 
high  and  affecting  numerous  elements  of  the  population.  It  is  expected  that 
much  attention  will  be  given  in  the  United  States  to  this  subject  in  the  near 
future.  The  possibility  of  great  saving  of  life  during  infancy  and  early  child- 
hood deserves  careful  consideration,  and  there  is  reason  to  believe  that,  even 
with  the  means  at  our  dispo.sal,  much  may  be  accomplished  at  present.  It  is 
probable  that  of  the  200,000  deaths  of  infants  in  the  registration  area  of  the 
United  States  a  saving  of  a  large  number  could  be  effected  if  proper  sanitary 
measures  were  generally  understood  and  practiced. 

The  death  rates  of  the  individual  States  vary  from  18.4  for  California  to  10.1 
for  South  Dakota.  California,  however,  and  likewise  Colorado  suffer  unduly 
in  comparison  with  other  States,  owing  to  the  fact  that  many  invalids  from 
other  parts  of  the  country  resort  to  them  in  search  of  health,  and  a  great  pro- 
portion of  the  mortality  could  no  doubt  be  traced  to  recent  residents. 

The  death  rates  per  thousand  population  in  the  larger  cities  were  as  follows : 

1907  1908 

New  York   18.5  16.8 

Chicago 15.3  14.0 

Philadelphia 18.7  17.4 

Boston 19.2  19.1 

New    Orleans    24.0  22.7 

St.   Louis    15.7  14.5 

Pittsburg   (including  Allegheny) 18.3  16.5 

Baltimore 19.9  18.3 

Washington,   D.   C 20.3  19.3 

Detroit 16.5  15.6 

Minneapolis 10.4  10.3 

Milwaukee 14.4  13.6 

Omaha 12.4  12.1 

Memphis  19.0  17.5 


CAUSES   OF   DEATH. 

Number  of 
Deaths,  1908. 

Typhoid  fever 11,375 

Measles 4,611 

Scarlet    fever    5,577 

Whooping  cough   4,969 

Diphtheria  (including  croup)  10,052 

Tuberculosis    (all    forms)..  78,289 

Cancer 33,465 

Heart  disease   60,038 

Pneumonia    (all  forms)....  61.259 

Diarrhea  and  enteritis 52,213 

B right's  disease   59,203 

Suicide 8.332 

Accident 44,037 


Death  rate  per 

100,000  estimated 

population. 

1907  1908 


30.3 

10.3 

10.3 

11.6 

24.3 

183.6 

73.1 

141.7 

161.2 

116.7 

94.6 

16.2 

109.7 


25.3 
10.2 
12.4 
11 

22.3 

173.9 

74.3 

133.3 

136.0 

116.0 

87.1 

18.5 

97.9 


192  FOURTH    INTERNATIONAL   SANITARY   CONFERENCE. 

AGES  OF  DECF.ASED. 

Males  Females 

Under  lOyears 112,638  93,049 

10  to  14      "     5,437  5,151 

15  to  19      "     9,317  8,828 

20  to  24      "     14,503  12,634 

25  to  34      "     31,642  26,049 

35  to  44      "     35,741  26,013 

45  to  54      "     39,120  27,725 

55  to  64      "     41,460  32,695 

65  and  over 84,961  83,710 

Unknown 678  223 


Total 375,497  316,077 

OCCUPATIONS   AND   CAUSES   OF   DEATH. 

In  an  effort  to  meet  the  urgent  demand  for  information  in  regard  to  the 
relation  of  occupation  to  mortality  some  statistics  covering  the  year  1908  have 
been  prepared  by  the  Bureau  of  the  Census.  The  information  furnished  is 
necessarily  incomplete,  comprising  only  74.6  of  the  total  number  of  deaths 
reported  of  male  persons  10  years  or  over,  and  11.7  of  the  deaths  of  females  of 
the  same  age,  and  valuable  as  the  data  given  may  be,  they  can  only  be  considered 
as  paving  the  way  for  more  complete  and  accurate  statistics  of  the  mortality  of 
occupations. 

From  the  imperfect  knowledge  so  far  gained,  some  very  important  facts  can 
be  gathered,  however.  The  figures  collected  show  that  in  the  registration 
area  of  the  United  States  30.9  deaths  out  of  every  100  deaths  of  occupied  males 
who  died  during  the  year  1908  between  the  ages  of  25  and  34  years  were  caused 
by  tuberculosis  of  the  lungs,  or  nearly  1  death  for  every  three.  In  the  same 
age  period  this  disease  was  responsible  for  41.9  deaths  out  of  every  100  deaths 
of  bookkeepers,  clerks  and  copyists ;  40.1  per  cent  of  the  barbers  and  hair- 
dressers ;  40.9  per  cent  of  the  servants ;  44.1  per  cent  of  the  boot  and  shoe- 
makers ;  49.2  per  cent  of  the  compositors,  printers  and  pressmen ;  41.2  per  cent 
of  the  tailors ;  while  its  ravages  among  farmers  fall  down  to  25.6,  and  among 
miners  and  quarrymen  to  5.3  per  cent.  It  is  curious  to  note  that  physicians  and 
surgeons  are  at  all  ages  below  the  average  as  to  deaths  caused  by  tuberculosis, 
and  show  the  smallest  or  near  to  the  smallest  proportion  of  all  professions  be- 
tween the  ages  of  35  and  54. 


VI.      MEASURES  FOR  THE  PROTECTION  OF  PASSENGERS  WHO  EMBARK   IN  VESSELS  FROM 

INFECTED  PORTS. 

The  regulations  deemed  advisable  by  the  Public  Health  and  Marine  Hospital 
Service  for  the  protection  of  passengers  may  be  resumed  as  follows : 

1.  When  practicable,  passengers  should  not  ship  from  an  infected  port. 

2.  No  person  suffering  from  a  quarantinable  disease,  or  scarlet  fever,  measles,, 
diphtheria,  or  other  communicable  disease,  should  be  allowed  to  ship. 

3.  Passengers,  for  the  purposes  of  these  regulations,  are  divided  into  two 
classes:  cabin  and  steerage. 

4.  Steerage  passengers  and  crews  coming  from  cholera-infected  districts  should 
be  detained  five  days  in  suitable  houses  or  barracks  located  where  there  is  no 
danger  from  infection,  and  all  baggage  disinfected. 

5.  Steerage  passengers  and  crews  from  districts  not  infected  with  cholera, 
shipping  at  a  port  infected  with  cholera,  unless  passed  through  without  danger 
of  infection  and  no  communication  allowed  between  such  persons  and  the  in- 
fected locality,  should  be  treated  as  those  in  the  last  paragraph. 

6.  Cabin  passengers  coming  from  cholera-infected  districts  embarking  at  a 
clean  or  an  infected  port  should  produce  satisfactory  evidence  as  to  their  exact 
places  of  abode  during  the  five  days  immediately  preceding  embarkation.  And 
if  it  appears  that  they  or  their  baggage  have  been  exposed  to  infection  the 
baggage  should  be  disinfected  and  the  passengers  detained  under  medical  super- 
vision a  sufficient  time  to  cover  the  period  of  incubation  since  last  exposure. 


FOURTH  INTERNATIONAL  SANITARY  CONFERENCE.  193 

7.  Steerage  passengers  and  crews  who,  in  the  opinion  of  the  inspecting  officer, 
have  been  exposed  to  the  infection  of  3'ellow  fever,  should  be  held  under  medical 
observation  in  a  place  free  from  danger  of  infection  for  a  period  of  five  days,  or 
six  in  some  cases,  before  embarkation. 

The  cases  where  we  apply  the  six  days  detention  is,  for  example,  between 
Havana  and  Key  West.  It  only  takes  a  ship  about  five  hours  to  make  this 
trip,  and  if  we  find  that  Cuba  is  infected  with  yellow  fever  we  detain  passengers 
six  days  at  Key  West,  inasmuch  as  they  arrive  in  the  United  States  the  same 
day  they  leave  Havana.  Now,  the  foregoing  regulations  are  required  at  all 
foreign  ports  by  the  United  States  Government  of  ships  on  their  departure  for 
any  port  in  the  United  States.  The  responsibility  for  their  enforcement  at  such 
ports  devolves  upon  the  U.  S.  Public  Health  and  Marine  Hospital  Service 
officers  detailed  for  duty  there. 

8.  Steerage  passengers  and  crew,  coming  from  districts  where  smallpox  pre- 
vails in  epidemic  form,  or  who  have  been  exposed  to  smallpox,  should  be 
vaccinated  before  embarkation,  unless  they  show  evidence  of  having  acquired 
immunity  to  smallpox  by  previous  attack  or  recent  successful  vaccination. 

9.  Steerage  passengers  and  crew  who,  in  the  opinion  of  the  inspecting  officer, 
have  been  exposed  to  the  infection  of  typhus  fever,  should  not  be  allowed  to 
■embark  for  a  period  of  at  least  twelve  days  after  such  exposure  and  the  disin- 
fection of  their  baggage. 

10.  Steerage  passengers  and  crew  who,  in  the  opinion  of  the  inspecting  officer, 
have  been  exposed  to  the  infection  of  plague  should  be  held  under  medical  ob- 
servation in  a  place  free  from  danger  of  infection  for  a  period  of  seven  days 
before  embarkation,  and  their  baggage  disinfected. 

11.  Cabin  passengers  coming  from  plague-infected  districts,  whether  embark- 
ing at  a  clean  or  an  infected  port,  should  produce  satisfactory  evidence  as  to 
their  exact  places  of  abode  during  the  seven  days  immediately  preceding 
embarkation.  .\nd  if  it  appears  that  they  or  their  baggage  have  been  exposed 
to  infection  the  baggage  should  be  disinfected  and  the  passengers  detained 
under  medical  supervision  a  sufficient  time  to  cover  the  period  of  incubation 
since  last  exposure. 

12.  Should  quarantinable  disease  appear  in  the  barracks  or  houses  in  which 
passengers  are  undergoing  detention,  no  passenger  from  said  houses  or  barracks 
who  has  been  presumably  exposed  to  this  new  infection  should  embark  until 
after  the  expiration  of  the  period  of  incubation  of  the  disease  in  question  sub- 
sequent to  the  last  exposure  to  infection  and  the  application  of  all  necessary 
sanitary  measures. 

13.  In  a  port  where  any  quarantinable  disease  prevails  the  personnel  of  vessels 
should  remain  on  board  during  their  stay  in  such  port. 

14.  Passengers  and  crews,  merchandise  and  baggage,  prior  to  shipment  at  a 
non-infected  port,  but  coming  from  an  infected  locality,  should  be  subject  to 
the  same  restrictions  as  are  imposed  at  an  infected  port. 

15.  The  master  of  a  vessel  should  observe  the  following  measures  on  board 
his  vessel : 

(a)  The  water-closets,  forecastle,  bilges,  and  similar  portions  of  the  vessel 
liable  to  harbor  infection  should  be  disinfected  and  frequently  cleansed. 

(b)  Free  ventilation  and  rigorous  cleanliness  should  be  maintained  in  all 
portions  of  the  ship  during  the  voyage,  and  measures  taken  to  destroy  rats, 
mice,  fleas,  flies,  roaches,  mosquitoes,  and  other  vermin. 

(c)  A  patient  sick  of  a  communicable  disease  should  be  isolated  and  one 
member  of  the  crew  detailed  for  his  care  and  comfort,  who,  if  practicable, 
should  be  immune  to  the  disease. 

(d)  Communication  between  the  patient  or  his  nurse  and  other  persons  on 
board  should  bo  reduced  to  a  minimum. 

(e)  Used  clothing,  body  linen,  and  bedding  of  the  patient  and  nurse  should 
be  immersed  at  once  in  boiling  water  or  in  a  disinfecting  solution. 

(fj  The  compartment  from  which  the  patient  was  removed  should  be  disin- 
fected and  thoroughly  cleansed.  Articles  liable  to  convey  infection  should  re- 
main in  the  compartments  during  the  disinfection  when  gaseous  disinfection 
is  used. 

(g)  Any  person  suffering  from  malaria  or  yellow  fever  should  be  kept  under 
mosquito  bars,  and  the  apartment  in  which  he  is  confined  closely  screened  with 
mosquito  netting.  All  mosquitoes  on  hoard  should  be  destroyed  by  burning 
pyrethrum   powder    (Persian    insect   powder)    or   by    fumigation    with    sulphur. 


194  FOURTH   INTERNATIONAL   SANITARY   CONFERENCE. 

Mosquito  larvae  (wigglers  or  wiggle-tails)  should  be  destroyed  in  water  bar- 
rels, casks,  and  other  collections  of  water  about  the  vessel  by  the  use  of  petroleum 
(kerosene)  ;  where  this  is  not  practicable,  use  mosquito  netting  to  prevent  the 
exit  of  mosquitoes  from  such  breeding  places. 

(h)  In  the  case  of  plague  special  measures  must  be  taken  to  destroy  rats, 
mice,  fleas,  flies,  ants,  and  other  vermin  on  board. 

(i)  In  the  case  of  cholera,  typhoid  fev^er,  or  dysentery,  the  drinking  water 
should  be  boiled  and  the  food  thoroughly  cooked.  The  discharges  from  the 
patient  should  be  immediately  disinfected  and  thrown  overboard. 

16.  An  inspection  of  the  vessel,  including  the  steerage,  should  be  made  by 
the  ship's  physician  once  each  day. 

17.  Should  cholera,  yellow  fever,  smallpox,  typhus  fever,  plague,  or  any  other 
communicable  disease  appear  on  board  a  ship  while  at  sea,  those  who  show 
symptoms  of  these  diseases  should  be  immediately  isolated  in  a  proper  place ; 
the  ship's  physician  should  then  immediately  notify  the  captain,  who  should 
note  same  in  his  log,  and  all  of  the  effects  liable  to  convey  infection  which  have 
been  exposed  to  infection  should  be  destroyed  or  disinfected. 

18.  The  hospital  should  be  disinfected  as  soon  as  it  becomes  vacant. 

19.  The  dead  should  be  enveloped  in  a  sheet  saturated  with  one  of  the  strong 
disinfecting  solutions,  without  previous  washing  of  the  body,  and  at  once  buried 
at  sea  or  placed  in  a  cofiin  hermetically  sealed. 

The  foregoing  regulations  are  now  required  by  the  United  States  Govern- 
ment to  be  complied  with  by  vessels  in  foreign  ports  before  their  departure  for 
any  port  in  the  United  States.  The  responsibility  for  their  enforcement  in  such 
ports  devolves  upon  officers  of  the  Public  Health  and  Marine  Hospital  Service 
detailed  for  duty  in  the  Am.erican  Consulates  or  upon  the  consular  officers 
issuing  the  bills  of  health  in  ports  where  medical  officers  are  not  on  duty. 


Vn.      DISEASES   NOT   INCLUDED   IN   THE  CONVENTION   OF    1905   AT   WASHINGTON,    WITH 
SOME   REMARKS   ABOUT   LEPROSY. 

The  time  has  apparently  arrived  for  a  concerted  action  on  this  continent  of 
ours  in  regard  to  such  diseases  as  trachoma,  favus,  beri-beri,  and  leprosy. 

In  the  paper  regarding  trachoma,  presented  by  Surgeon-General  Wyman  at 
the  Conference  at  Mexico,  mention  was  made  of  the  fact  that  since  1897  trachoma 
has  been  considered  as  a  "dangerous  contagious"  disease  in  the  United  States, 
and  in  accordance  with  the  immigration  law  of  1891  all  arriving  aliens  so  af- 
flicted have  been  refused  entrance  to  the  country.  Immigrants  suffering  from 
any  other  of  these  diseases  are  likewise  refused  admittance  under  the  above  law. 

The  reports  submitted  by  the  Delegates  to  the  previous  Convention  showed  that 
trachoma  and  beri-beri  were,  at  the  time,  practically  unknown  in  Colombia, 
Costa  Rica,  Ecuador,  Guatemala,  Honduras  and  Salvador,  while  laws  similar 
to  those  of  the  United  States  were  enforced  against  the  introduction  of  trachoma 
in  Brazil,  Cuba,  and  Mexico,  and  also  in  regard  to  beri-beri  in  Mexico  and 
Uruguay. 

In  regard  to  leprosy,  a  co-ordinate  action  is  especially  desirable.  The  realiza- 
tion has  become  more  and  more  general  that  in  order  to  check  the  progress  of 
this  loathsome  disease  it  is  not  enough  to  prevent  the  introduction  of  new  cases 
from  countries  like  China,  Japan  and  India,  where  it  is  endemic,  but  that  the 
control  of  existing  cases  must  be  secured  by  the  one  policy  that  has  proved 
successful,  namely,  segregation.  It  is  a  matter  of  history  that  leprosy,  once 
the  scourge  of  the  world  in  the  Middle  Ages,  searching  for  its  victims  alike  on 
the  throne  and  among  the  masses,  was  practically  stamped  out  when  the  people, 
awakening  to  the  seriousness  of  its  ravages,  put  into  practice  a  system  of  vigor- 
ous isolation,  which,  if  somewhat  cruel  in  its  enforcement,  was  effective  in  its 
results.  The  disappearance  of  the  disease  was  soon  followed  by  an  absolute 
neglect  of  all  precautionary  measures,  with  the  result  that  leprosy,  considered 
extinct  in  Europe  in  the  eighteenth  century,  has  again  obtained  a  foothold  there. 

It  is  unnecessary  to  dwell  here  on  the  various  circumstances  (colonial  expan- 
sion, extension  of  commerce,  free  intercourse  with  infected  countries)  which 
have  brought  about  these  conditions.  It  is  desired  to  call  attention  to  the  fact 
that  if  the  principle  of  the  contagiousness  of  leprosy  is  once  ignored,  the  spread 
of  this  affliction   is   only   a  matter  of  time.     It  is   found,   among   many   other 


FOURTH  INTERNATIONAL  SANITARY  CONFERENCE.  195 

instances,  that  in  Hawaii,  where  no  cases  were  heard  of  before  the  fifties,  its 
introduction  was  soon  followed  by  such  diffusion  that  it  has  now  become 
a  serious  problem  for  the  Territory.  In  the  State  of  Louisiana,  where  the 
disease  probably  had  no  existence  140  years  ago,  the  number  of  leprous  beggars 
in  the  streets  of  New  Orleans  was  so  large  in  1786  that  the  authorities  had  to 
isolate  them  in  a  home  established  outside  of  the  city.  This  measure  caused, 
if  not  the  eradication  of  the  disease,  at  least  its  disappearance  from  sight  until, 
owing  to  the  apathy  of  the  people,  it  recurred  with  unexpected  violence  in  the 
seventies,  and  obliged  the  Board  of  Health  to  take  immediate  steps  for  the  segre- 
gation of  all  known  cases.  In  Colombia,  South  America,  the  number  of  afflicted 
persons,  which  was  estimated  forty  years  ago  at  4Q0,  is  now  counted  by  the 
thousands.  A  similar  observation  has  been  made  in  Algeria.  In  this  French 
colon}',  the  disease,  which  was  very  rare  as  late  as  1897,  has  shown  an  alarming 
increase  since  the  immigration  of  several  Spanish  lepers. 

No  country  or  race  is  entirely  free  from  leprosy  nowadays.  No  climate  can 
claim  immunity  from  it,  although  it  has  been  noted  that  it  thrives  especially 
in  damp  regions  near  the  seacoast,  and  is  seldom  found  in  mountainous  or 
elevated  regions. 

The  United  States  has  a  relatively  small  proportixjn  of  cases,  distributed  chiefly 
in  the  four  States  of  Louisiana,  Florida,  Minnesota  and  California.  It  was 
brought  into  the  first  two  States  from  the  West  Indies,  introduced  in  Minnesota 
by  the  Scandinavian  immigrants,  and  in  California  from  the  Far  East.  A 
commission  of  officers  of  the  Public  Health  and  Marine  Hospital  Service,  ap- 
pointed under  an  Act  of  Congress  for  the  investigation  of  the  disease,  could  find 
record  of  only  278  cases  in  1900,  but  it  is  believed  that  the  actual  number  con- 
siderably exceeds  these  figures.  The  great  majority  of  the  States  and  Terri- 
tories in  the  continental  part  of  the  United  States  requires  the  reporting  and 
segregation  of  cases  of  leprosy,  and  classes  the  disease  as  dangerous  and 
communicable. 

This  policy  has  been  followed  for  some  time  in  Louisiana,  the  Leper  Home 
in  that  State  containing  about  60  patients  ordinarily.  In  Massachusetts,  where 
segregation  is  vigorously  enforced,  a  leper  hospital  has  recently  been  provided 
by  the  State.  Texas  made  provision  in  1909  for  the  establishment  of  an 
institution  of  this  kind,  and  Porto  Rico  already  has  in  operation  one  of  a 
similar  nature  which  is  located  on  one  of  the  small  neighboring  islands.  The 
trend  of  opinion  seems,  however,  to  be  in  favor  of  a  Federal  Leprosarium  in 
which  all  the  lepers  of  the  United  States  proper  may  be  cared  for.  A  bill  was 
once  introduced  in  Congress  for  this  purpose,  but  its  passage,  owing  to  several 
causes,  could  not  be  secured  at  the  time. 

As  experienced  in  Louisiana  and  Hawaii,  there  are,  no  doubt,  great  difficulties 
connected  with  a  policy  of  segregation,  but  if  a  proper  sense  of  responsibility 
can  be  awakened  among  the  people  these  will  be  overcome.  One  v.'hich  may 
often  prove  serious  is  the  difficulty  in  arriving  at  a  definite  diagnosis  in  many 
cases.  We  had  in  our  national  capital  an  object  lesson  some  time  ago  in  a 
patient  pronounced  a  leper  by  the  local  health  authorities  and  isolated  in  accord- 
ance with  this  diagnosis  (confirmed  soon  afterwards  by  one  of  the  world's 
foremost  experts).  This  patient  was  afterwards  removed  to  New  York  and 
allowed  to  remain  at  large  with  his  family.  This  case  is  only  cited  as  an  illus- 
tration of  the  divergency  of  opinion  among  experts  and  the  obscurity  still  sur- 
rounding some  of  the  phases  of  this  disease. 

It  is  partly  in  order  to  remedy  this  defect  by  obtaining  a  better  and  more 
accurate  knowledge  of  all  the  factors  involved  in  the  solution  of  this  problem 
that  the  United  States  established  the  investigation  station  on  the  Island  of 
Molokai,  Hawaii.  This  station,  made  possible  by  the  action  of  Congress, 
is  now  in  operation  under  officers  of  the  Public  Health  and  Marine  Hospital 
Service.  Studies  of  leprosy  are  being  carried  on  there  with  the  purpose  of 
determining  the  relative  value  of  different  preparations  in  the  treatment  of 
the  disease,  and  special  attention  is  paid  to  the  care  and  treatment  of  lepers  in 
Hawaii.  So  far  as  can  be  ascertained,  this  is  the  first  institution  ever  organized 
by  any  government  for  the  continuous  scientific  investigation  of  leprosy,  and 
there  is  no  doubt  that  the  data  secured,  covering  as  they  will  a  vast  field  of 
experimentation,  will  prove  of  immense  value  in  connection  with  all  future 
work  concerning  this  disease. 


196  FOURTH    INTERNATIONAL   SANITARY   CONFERENCE. 

PROTECTIVE    MEASURES    AGAINST    FOREIGN    INFECTION. 

!  By  Passf.d  Assistant  Surgf.on  R.  H.  von  Ezdorf, 

U.  S.  Public  Health  and  Marine  Hospital  Service. 

The  sources  of  infectious  diseases  in  a  communitj-  are  two,  namely:  tho.se 
from  the  place  itself  or  country  in  which  the  place  is  located,  that  is,  domestic; 
and  second,  that  from  foreign  countries. 

It  is  my  purpose  to  deal  with  the  subject  of  the  foreign  source  chiefly,  and 
the  preventive  measures  which  should  be  taken  in  relation  thereto.  Naturally 
the  seaport  towns  are  the  places  most  subject  to  this  source  of  infection. 

The  seaports  bear  a  greater  responsibility  toward  the  rest  of  the  country  than 
any  inland  towns  because  they  are  the  gateways  of  commerce,  and  intercom- 
munication with  foreign  states,  and  are  thereby  constantly  menaced  by  foreign 
infection.  When  they  protect  themselves  they  also  protect  the  rest  of  the 
country. 

Nations  are  alive  to  this  point,  and  in  many  instances  the  nation  comes  to 
the  aid  of  the  seaport  in  the  sanitation  of  the  place. 

Take  for  example  cities  like  Havana  and  Vera  Cruz  which  in  the  past  were 
endemic  foci  for  yellow  fever.  Much  has  been  done  toward  eliminating  the 
stegomyia  mosquito  responsible  for  the  transmission  of  yellow  fever,  and  as  a 
consequence  an  epidemic  of  yellow  fever  in  those  places  will  not  occur  again 
if  the  measures  are  continued.  A  new  factor  therefore  enters  in  considering 
the  quarantine  of  such  places.  Without  the  report  of  cases  of  yellow  fever 
for  a  long  period  of  time  there  will  be  no  such  quarantine  restrictions  as  the 
detention  of  vessels  and  persons  from  those  places  as  was  the  case  in  the 
past.  This  is  reasonably  safe,  yet  as  those  territories  remain  infectible  so 
long  as  the  factor  of  the  stegomyia  mosquito  remains,  an  element  of  danger 
is  to  be  considered.  In  former  years  when  a  case  occurred  there  followed 
an  epidemic  giving  us  a  warning  of  what  was  taking  place  and  of  the  presence 
of  infection.  Now,  however,  should  unknown  infection  creep  in,  its  presence 
may  not  be  discovered  for  some  time,  and  thus  its  possible  spread  to  another 
country  may  occur. 

The  freedom  from  infectious  disease  or  rather  the  protection  from  disease 
from  the  foreign  source,  which  if  it  enters  may  spread  over  the  entire  country, 
is  properly  a  national  problem. 

As  it  has  a  national  bearing,  it  seems  but  proper  that  the  nation  should  come 
to  the  aid  of  the  seaport  and  bear  a  portion  of  the  responsibility. 

The  measures,  however,  which  should  be  adopted  and  maintained  for  the 
protection  against  foreign  infection  may  be  resolved  into  three  heads: 

1.  Sanitation  of  the  seaport. 

2.  Quarantine. 

3.  Inspection  of  arriving  individuals  beyond  the  period  of  incubation  of  cer- 
tain diseases. 

For  many  jears  Surgeon-General  Wyman  has  advocated  the  most  logical 
form  of  protection,  namely,  the  sanitation  of  the  seaports.  I  will  quote  the 
following  from  his  letter  to  Secretary  Root  suggesting  propositions  for  con- 
sideration at  the  Third  Conference  of  American  States,  held  in  Rio  de  Janeiro, 
July,  1906. 

"In  considering  the  possibility  of  an  international  agreement  for  more  direct 
and  effective  influence  of  the  national  governments  in  local  sanitation  and 
hygiene  it  will  be  more  practicable  to  limit  such  agreement  to  seaport  cities 
and  towns  since  these  are  the  points  of  contact  between  nations." 

In  our  own  country  every  effort  is  being  made  to  realize  the  best  sanitary 
conditions,  but  as  these  have  not  and  will  not  be  complete  for  many  years  to 
come,  we  are  forced  to  adopt  preventive  and  protective  measures. 

The  traffic  between  seaports  is  increasing  from  year  to  year,  and  with  modern 
facilities  for  travel,  the  different  peoples  are  brought  intimately  in  contact  and, 
therefore,  offers  better  opportunities  for  the  spread  or  importation  of  their 
infectious  diseases. 

The  seaport  city  or  town  should  be  first  in  the  matter  of  perfecting  its 
state  of  sanitation  in  order  that  in  the  event  a  quarantinable  disease  should 
appear  in  its  midst,  it  will  not  spread,  and  commerce,  which  is  the  life  of  a 
seaport,  could  go  on  unrestricted.     This  accomplished,  naturally  no  fear  from 


FOURTH  INTERNATIONAL  SANITARY  CONFERENCE.  197 

foreign  infection  would  need  be  considered;  besides  obtaining  security  against 
infection  spreading  from  it  to  a  foreign  port. 

The  Quarantine  Service  at  each  port  is  the  next  defense  established  to  protect 
the  seaport  and  nation  from  foreign  invasions  of  disease.  This  service  cannot 
be  absolute,  for  many  reasons,  but  may  render  a  service  which  will  restrict  or 
better  reduce  to  a  minimum  the  chances  of  an  infectious  disease  finding  entry. 
At  present  the  chief  function  of  the  Quarantine  Service  is  to  prevent  the 
admission  of  quarantinable  diseases,  which  are  the  following:  Yellow  fever, 
smallpox,  typhus  fever,  plague,  cholera  and  leprosy. 

Regulations  outlining  measures  to  be  adopted  against  vessels  are  promulgated 
by  the  Secretary  of  the  Treasury  upon  the  recommendation  of  the  Surgeon- 
General,  Public  Health  and  Marine  Hospital  Service.  These  regulations  are 
divided  into :  those  to  be  observed  at  foreign  ports ;  those  to  be  observed  at 
domestic  ports. 

The  quarantine  regulations  to  be  observed  at  foreign  ports  are  for  the 
purpose  of  securing  the  best  sanitary  condition  of  a  vessel,  its  cargo,  passengers 
and  crew  before  sailing  for  a  port  in  the  United  States. 

Under  the  quarantine  laws  vessels  are  required  before  clearing  for  a  port 
in  the  United  States  to  obtain  bills  of  health  from  our  consular  officers.  These 
bills  of  health  give  the  required  information  to  the  quarantine  officer  in  the 
United  States  port  regarding  the  health  conditions  of  the  port,  the  sanitary 
history  of  the  vessel,  cargo,  and  personnel  on  board  at  the  time  of  its  issuance. 

Under  the  same  law  medical  officers  may  be  detailed  by  the  President  to  the 
consular  offices  to  issue  such  bills  of  health  and  enforce  our  quarantine  regula- 
tions to  be  observed  at  foreign  ports.  These  medical  officers  are  selected 
by  the  Surgeon-General,  Public  Health  and  Marine  Hospital  Service,  and  usually 
assigned  to  ports  known  to  be  infected  or  suspected  with  a  quarantinable  dis- 
ease, or  in  ports  having  communication  with  such  ports,  whenever  it  is  deemed 
that  additional  protection  to  our  ports  is  thereby  secured. 

A  brief  resume  of  these  regulations  may  here  be  of  interest.  The  officer  at 
the  foreign  port  issuing  a  bill  of  health  is  authorized  to  withhold  it  until 
satisfied  that  all  the  quarantine  laws  and  regulations  of  the  United  States  have 
been  complied  with.  When  medical  officers  are  detailed  to  a  foreign  port  bills 
of  health  are  not  issued  by  him  until  all  the  facts  have  been  ascertained  and 
determined  by  an  actual  inspection. 

The  regulations  specify  that  an  inspection  is  required  of: 

(a)  All  vessels  from  ports  at  which  cholera,  yellow  fever,  or  plague  prevails, 
or  at  which  smallpox  or  typhus  fever  prevails  in  epidemic  form. 

(b)  All  vessels  carrying  steerage  passengers. 

The  inspection  includes  the  examination  of  the  vessel;  passengers  and  crew; 
manifests  and  other  papers;  food  and  water  supply;  information  as  to  com- 
munication with  shore ;  possibility  of  invasion  by  small  animals,  etc.,  to  deter- 
mine if  all  regulations  have  been  complied  with. 

The  regulations  then  take  up  in  detail  the  requirements  with  regard  to  vessels, 
the  passengers  and  crew,  with  respect  to  clean  ports  as  well  as  ports  where 
quarantinable  disease  prevails. 

We  have  a  regulation  stating  that  no  person  suffering  with  a  quarantinable 
disease,  or  scarlet  fever,  measles,  diphtheria,  or  other  communicable  disease, 
should  be  allowed  to  embark. 

Before  passengers  and  crew,  who  have  been  presumably  exposed  to  one  of 
the  quarantinable  diseases  by  reason  of  its  presence  in  the  seaport  or  district 
from  which  they  come,  are  permitted  to  embark,  the  following  requirements 
must  be  observed : 

For  cholera :  5  days  detention  or  observation,  disinfection  of  baggage. 

Smallpox  in  epidemic  form :  Vaccination  or  other  evidence  of  immunity. 

Typhus  fever:  12  days  should  elapse  after  supposed  last  exposure;  disinfection 
of  baggage.  

Plague :  7  days  detention  or  observation ;  dismfection  of  baggage. 

Yellow  fever:  5  days  detention  or  immunity. 

All  steerage  baggage  is  labeled;  a  red  label  is  used  when  "passed";  a  yellow 
label  is  used  when  "disinfected."  These  labels  bear  the  date  and  seal  of  the 
inspecting  officer. 

The  requirements  and  measures  to  be  observed  on  board  a  vessel  at  sea  are 
given  and  are  advisory  in  character. 


198  FOURTH    INTERNATIONAL   SANITARY   CONFERENCE. 

These  relate  to: 

(a)  Water  closets,  forecastle,  bilges  to  be  kept  clean. 

(b)  Ventilation  and  cleanliness,  and  measures  for  destroying  rats,  mice,  flies, 
roaches,  mosquitoes  and  other  vermin. 

(c)  Isolation  of  sick  and  measures  to  be  taken  with  regard  to  quarantinable 
diseases  as  well  as  malaria,  typhoid  or  dysentery  cases. 

Notation  of  all  sickness  is  required  to  be  made  in  the  log,  and  clinical  records 
of  all  cases  of  sickness  on  board  delivered  to  the  quarantine  officer  by  the 
ship's  surgeon. 

The  observance  of  these  regulations  tends  to  relieve  the  stringency  of  quar- 
antine measures  at  the  port  of  arrival.  The  quarantine  regulations  for  domestic 
ports  were  fully  considered  at  the  Second  International  Sanitary  Convention, 
but  in  protecting  one's  own  port,  there  is  a  certain  amount  of  protection,  while 
indirect,  secured  to  the  foreign  port  having  direct  communication  with  it. 

In  dealing  with  vessels  from  foreign  countries,  ports  are  classed  as  infected, 
suspected,  and  clean. 

AH  vessels  from  foreign  ports,  excepting  Canadian  ports,  are  subject  to 
inspection. 

A  vessel  arriving  at  the  quarantine  station  is  boarded  by  the  medical  officer 
who  obtains  a  declaration  from  the  Captain  or  Master  relative  to  the  history 
of  the  vessel,  its  cargo,  passengers,  and  crew.  Papers  such  as  bills  of  health, 
manifests,  and  sometimes  the  ship's  log,  are  examined  to  verify  the  statements. 
An  inspection  of  all  persons  on  board  is  made  to  determine  as  to  the  health  of 
such  persons. 

Now  these  vessels  are  treated  according  to  whether  they  have  touched  infected, 
suspected,  or  clean  ports.  If  the  history  of  the  vessel  is  clean,  and  all  persons 
on  board  are  found  to  be  in  good  health,  such  vessel  is  given  free  pratique 
to  enter  the  port. 

If  the  vessel  is  from  a  suspected  or  infected  port  then  the  regulations,  gov- 
erning the  particular  quarantinable  disease,  are  enforced. 

If  sickness  occurs  on  board,  or  has  occurred  on  board  sometime  during  the 
voyage,  whether  the  vessel  is  from  a  clean  port  or  not,  the  Quarantine  Officer 
is  required  to  determine  if  the  illness  is  or  was  a  quarantinable  disease  or  not. 

In  this  matter  the  Quarantine  Officer  holds  an  unenviable  position.  Should 
he  determine  or  diagnose  the  case  of  illness  as  not  quarantinable,  and  the 
illness  afterwards  develops  as  a  quarantinable  disease,  in  the  seaport,  it  will 
be  seen  what  damage  or  what  the  consequences  may  be. 

Again  if  the  vessel  is  held  and  treated  for  having  a  quarantinable  disease,  and 
the  case  afterwards  proves  to  be  non-quarantinable,  considerable  financial  loss 
has  been  caused  to  the  shipping  interests. 

A  quarantinable  disease  may  occur  on  board  a  vessel  from  a  supposed  clean 
port — it  has  occurred  and  will  occur  again.  It  simply  necessitates  constant  and 
vigilant  care,  even  in  dealing  with  clean  ports. 

It  will  be  seen  from  this  that  in  dealing  with  territory  regarded  as  clean,  yet 
infectible  territory  withal,  how  some  quarantinable  disease  may  find  entry. 
The  individual  from  such  place  may  be  in  good  health  upon  arrival  at  the 
quarantine  station,  yet  be  in  the  incubative  period  of  a  quarantinable  disease, 
which,  developing  after  arrival  in  the  seaport,  may  be  the  beginning  of  an 
epidemic,  all  other  conditions,  of  course,  being  favorable  for  its  spread.  The 
importance  of  having  the  seaport  in  such  a  high  degree  of  sanitation  thereby 
becomes  more  apparent. 

As  vessels  are  arriving  from  supposedly  clean  ports,  yet  infectible  territory, 
and  are  passing  within  the  incubative  period  of  a  quarantinable  disease,  the 
next  or  third  measure  of  defense  against  foreign  invasion  becomes  apparent, 
namely :  the  surveillance  of  the  persons  arriving  at  the  seaport  until  the  incuba- 
tive period  of  the  quarantinable  disease  has  passed. 

At  New  Orleans,  Mobile,  and  Galveston  sn.ch  a  service  has  been  maintained 
by  the  Government  under  the  administration  of  the  Public  Health  and  Marine 
Hospital  Service.  Persons  arriving  from  a  foreign  tropical  port  were  inspected 
daily  until  six  (6)  days  had  passed  since  their  leaving  the  last  foreign  port, 
or  in  other  v.-ords,  the  last  source  of  possible  exposure  to  infection  of  yellow 
fever;  this  being  the  disease  in  which  the  Southern  ports  are  chiefly  concerned. 

A  discussion  of  the  practice  followed  at  the  New  Orleans  Quarantine  Station 
may  be  of  interest  in  this  connection. 


FOURTH  INTERNATIONAL  SANITARY  CONFERENCE.  199 

The  traffic  has  been  chiefly  with  tropical  ports  where  yellow  fever  has  prevailed 
in  the  past,  and  which  territory  still  remains  infectible  considering  the  factor  of 
the  presence  of  the  stegomyia  to  make  it  such.  The  inspection  of  all  persons 
from  these  tropical  ports  consists  in  a  careful  visual  inspection,  and  the  taking 
of  the  temperature  by  clinical  thermometer  of  each  and  every  individual.  When 
a  person  was  found  with  a  temperature  of  37.3  C,  equals  99.2  F.,  or  over,  he 
was  held  to  one  side  subject  to  a  second  and  more  critical  inspection.  If  the 
temperature  was  37.8  C,  equal  to  100  F.,  or  over,  the  individual  was  removed 
from  the  vessel  to  the  Quarantine  Hospital  for  observation  and  treatment.  In 
case  the  individual  presented  some  symptom  regarded  as  suspicious  of  a  quaran- 
tinable  disease,  the  vessel,  though  from  a  supposed  clean  port,  and  otherwise 
clean  history,  was  held  pending  the  diagnosis  of  the  case.  If  there  was  no 
symptom  indicative  of  a  quarantinable  disease,  yet  with  fever  present  as  indi- 
cated by  the  temperature,  the  Quarantine  Officer  assumed  the  responsibility  that 
no  quarantinable  disease  was  complicating  the  case,  and,  therefore,  allowed  the 
vessel  to  proceed,  detaining  the  individual  for  observation. 

As  the  individual  is  the  main  factor,  if  not  the  chief  source  in  spreading  dis- 
ease, the  detention  and  isolation  of  a  sick  individual  with  an  infectious  disease 
is  the  best  that  can  be  accomplished.  The  isolation  of  a  known  source  of  in- 
fection entirely  eliminates  that  source  for  further  spread. 

During  the  period  April  1,  1907,  to  December  1,  1909,  there  were  removed  to 
the  New  Orleans  Quarantine  Station  Hospital  395  persons  for  observation. 
None  of  these  presented  a  quarantinable  disease.  The  following  is  a  partial 
list  of  the  diseases  treated : 

Malaria 112  cases 

Of  which  54  were  of  the  aestivo  autumnal  variety. 

Typhoid  fever    29  cases 

Tuberculosis 11  cases 

Beri-beri 1  case 

Mumps 1  case 

General  diseases   241  cases 

How  much  good  for  the  port  of  New  Orleans  was  accomplished  by  the  isola- 
tion of  these  cases  may  be  only  conjectured. 

Under  the  Quarantine  Regulations  the  following  regulation  appears : 

"Par.  67.  When  a  vessel  arriving  at  Quarantine  has  on  board  any  of  the  com- 
municable but  non-quarantinable  diseases  the  Quarantine  Officer  shall  promptly 
inform  the  local  health  authorities  of  the  existence  of  such  disease  aboard,  and 
shall  make  every  effort  to  furnish  such  notification  in  ample  time,  if  possible,  to 
permit  of  the  case  being  seen  by  the  local  authorities  before  discharge  from 
the  vessel." 

The  health  authorities  may  or  may  not  take  measures  for  protecting  themselves 
against  foreign  infectious  disease;  they  may  have  enough  to  attend  to  in  their 
own  community.  Certainly  they  should  not  be  required  to  take  care  of  this 
foreign  source  of  infection.  The  nation  is  as  much  interested  as  they  are  that 
the  seaport  be  as  free  from  infection  as  possible,  as  this  same  infection  may 
be  the  source  of  spread  to  places  outside  of  the  seaport  city,  that  is  to  another 
foreign  port,  or  interior  points.  I  believe  it  should  be  the  function  of  the  nation 
to  protect  them  and,  therefore,  isolate  all  such  persons  upon  arrival  with  an 
infectious  disease  in  the  active  stage  of  illness  at  the  Quarantine  Station.  Natu- 
rally we  could  not  apply  this  to  persons  in  the  incubative  period  of  such  disease 
as  we  have  no  practical  way  of  determining  that  point.  I  do  not  wish  to  have 
it  understood  that  I  mean  that  quarantine  restrictions  should  be  applied,  but 
only  the  individual  arriving  in  the  active  period  of  some  disease  supposedly 
infectious.  Such  measures  as  proposed  would  affect  but  a  small  per  cent  of 
persons,  and,  therefore,  be  no  particular  hardship;  certainly  our  people  would 
profit  thereby,  and  that,  after  all,  is  the  purpose  of  maintaining  protective 
measures. 

I  have  given  only  a  list  of  those  detained;  a  list  of  those  passed  may  give  an 
idea  also  of  what  has  to  be  contended  with. 


200  FOURTH    INTERNATIONAL   SANITARY   CONFERENCE. 

During  the  fiscal  year  July  1,  1908,  to  July  1,  1909,  the  following  is  a  list 
of  diseases  in  persons  passed  on  vessels : 

Typhoid  fever    6  cases 

Malaria    confirmed    microscopically 19  cases 

Tuberculosis  confirmed  microscopically 6  cases 

Pneumonia 3  cases 

Dysentery 1  case 

Impetigo   contagiosa    1  case 

General    diseases    35  cases 

Scarlet  fever   (from  a  domestic  port) 1  case 

The  individual  suffering  from  any  disease  not  quarantinable,  once  passed,  will 
seek  his  own  medical  attendance  or  advice,  as  he  sees  fit,  or  continue  his  voyage 
to  some  interior  point,  provided,  of  course,  that  the  particular  disease  is  not 
quarantinable   under  the  local   sanitary   regulations. 

On  an  average,  about  41,000  crew  and  10,000  passengers  are  inspected  at 
this  station  each  year.  Of  this  number  an  average  of  about  132  persons  were 
detained,  chiefly  made  up  of  members  of  crews,  leaving  but  a  small  fraction  of  a 
per  cent  of  passengers  detained. 

It  appears  to  me,  therefore,  that  the  function  of  a  quarantine  station  should 
be  extended  to  isolating  all  cases  of  fever  and  detaining  them  if  they  prove 
infectious.  I  would  include  malarial  fever,  as  the  territory  of  the  South  has 
anopheles  mosquitoes  and,  therefore,  may  increase  this  form  of  infection.  Per- 
sons suffering  with  malaria  or  tuberculosis  would  receive  instructions  as  to  the 
care  to  be  taken  in  avoiding  the  spread  of  their  infection.  Tuberculosis  is 
already  barred  under  the  immigration  laws,  that  is,  in  the  alien ;  but  there  are 
Americans  who  are  ignorant  of  their  affection ;  likewise  aliens  apparently  in 
good  health  have  been  discovered  by  means  of  the  thermometer,  and  thus  cases 
of  laryngeal  tuberculosis  has  been  discovered  in  the  incipiency  of  the  disease. 
These  persons  would  pass  ordinary  muster. 

I  would,  therefore,  conclude  that  the  elimination  of  the  foreign  source  of 
infection  is  an  important  factor  for  the  community,  and  particularly  a  seaport 
city  or  town ;  that  the  sanitation  of  such  city  is  of  first  importance,  and  failing 
perfect  conditions,  protective  measures  for  eliminating  the  source  of  foreign 
infection  is  essential,  and  the  only  other  measures  which  can  be  adopted  or 
are  practicable  are  the  two  mentioned  and  discussed. 

That  quarantine  service  be  extended  to  include  as  its  function  the  isolation 
of  all  infectious  diseases,  so  far  as  practicable,  arriving  on  vessels,  in  addition 
to  its  main  function  of  preventing  the  admission  of  the  quarantinable  diseases. 
That  the  inspection  of  individuals  landing  at  the  port  of  entry  be  under  sur- 
veillance for  a  period  of  time  to  intercept  any  person  in  the  incubative  period 
of  some  transmissible  disease. 


FOURTH  INTKRNATIONAL  SANITARY  CONFERENCE.  201 


REPORT  OF  THE  DELEGATION  OF  VENEZUELA.  COM- 
POSED BY  DOCTORS  P.  ACOSTA  ORTIZ  AND  LUIS 
RAZETTL 

Mr.  President  and  Messrs.  Delegates  of  the  Conference :  In  compliance  with 
the  provisions  of  the  provisional  program  for  this  International  Sanitary  Con- 
ference of  the  American  Republics,  we  have  the  honor  to  present  the  following: 

Report  in  Regard  to  the  Sanitary  Conditions  in  Venezuela. 

Venezuela,  being  located  in  the  extreme  end  of  South  America,  between  1°  40' 
south  latitude  and  12°  26'  north  latitude,  is  found  fully  within  the  tropical  zone. 
Its  extensive  area  of  1,552,741  square  kilometers  is  occupied  by  a  small  popula- 
tion of  2,323,527  inhabitants.  The  climate  of  the  country  varies  according  to 
the  elevation  over  the  sea  level.  In  the  cold  lands  of  the  Merida  Mountains, 
whose  highest  peaks  raise  up  to  4,526  meters,  the  thermometer  registers  2  or  3 
degrees  centigrade  below  zero;  in  temperate  lands  the  temperature  ranges  from 
18  to  35  degrees  centigrade ;  and  in  the  hot  lands  it  varies  between  25  and  32 
degrees  centigrade.  Its  vast  plains,  which  cover  an  area  of  over  400,000  square 
kilometers,  are  flooded  during  the  rainy  season,  and  when  the  waters  withdraw 
there  are  left  big  swamps  which  make  splendid  breeding  places  of  mosquitoes, 
the  means  of  transmission  of  malaria,  the  great  endemic  of  the  tropical  countries. 

Besides  malaria,  there  prevail  in  Venezuela  all  the  diseases  which  are  char- 
acteristic of  the  intertropical  zone,  to  wit :  Yellow  fever,  dysentery,  beri-beri, 
leprosy,  phylariosis,  ankylostomiasis,  pustule,  etc. ;  there  are  also  other  endemic 
diseases,  such  as  tuberculosis,  typhoid  fever,  syphilis,  etc. 

Up  to  1908  the  bubonic  plague  had  not  invaded  our  country.  On  account  ef 
the  importance  of  this  disease  in  regard  to  international  relations,  we  believe  it 
our  duty  to  begin  this  report  with  a  succinct  statement  concerning  the  develop- 
ment of  that  epidemic. 

PLAGUE  IN  VENEZUELA. 
the  epidemic  in  la  guaira. 
Venezuela  had  been  immune  from  plague  up  to  the  early  part  of  1908,  and 
it  was  introduced  in  the  country  through  La  Guaira,  the  principal  port  of  the 
Republic,  distant  28  kilometers  from  the  capital.  Just  as  it  happened  everywhere 
else,  the  first  cases  passed  unnoticed  by  the  sanitary  authorities.  It  was  in  the 
month  of  April  when  the  bacteriologist.  Doctor  Rafael  Rangel,  who  had  been 
purposely  sent  by  the  Government  to  study  the  nature  of  the  disease,  unknown 
to  the  physicians  in  the  country,  determined  its  diagnosis. 

It  is  not  definitely  known  how  the  disease  was  introduced  in  our  country. 
The  most  correct  opinion  is  that  it  was  brought  by  the  Italian  steamer  "Cita 
de  Torino,"  which,  coming  from  Colon,  landed  the  cadaver  of  a  priest  from 
Guayaquil,  a  port  at  that  time  infected  by  the  plague.  The  four  men  who  buried 
his  body  were  the  first  to  be  attacked  by  the  disease,  but  as  it  was  uiiknown 
then,  no  diagnosis  was  made. 

On  April  15,  1908,  Doctor  Rangel,  after  careful  investigations,  was  able  to 
verify  the  nature  of  the  disease,  and  from  that  day  on  the  campaign  against  the 
scourge  was  undertaken.  That  campaign  consisted  of  the  isolation  of  patients  in 
the  lazaretto,  the  disinfection  of  dwellings,  the  immunization  with  Yersin  serum 
of  persons  living  in  infected  houses;  the  systematic  destruction  of  rats;  the 
inoculation  of  HafFkine  Lymph  into  all  inhabitants  of  the  city,  and  the  enforce- 
ment of  the  general  rules  of  public  and  private  hygiene. 

The  movement  of  the  lazaretto  of  La  Guaira,  from  April  15th  to  July  10, 
1908,  was  as  follows : 

Total  number  of  cases  64 

Men 40 

Women  9 

Children   15 

According  to  the  forms  of  the  disease : 

Bubonic  plague    48 

Pneumonic   plague    6 

Septicemic  plague    2 

Associated  plague  8 


202  FOURTH    INTERNATIONAL   SANITARY   CONFERENCE. 

Of  these  64  cases,  38  died,  which  is  equivalent  to  a  general  death  rate  of 
59.37  per  cent.  However,  in  cases  treated  from  the  beginning  with  high-dosed 
serum  and  by  extirpation  of  the  infected  ganglions,  the  mortality  decreased  to 
16.66  per  cent,  as  was  proven  by  Dr.  F.  Mendoza. 

It  is  impossible  to  determine  the  exact  number  of  cases  of  plague  that  oc- 
curred in  La  Guaira  from  the  middle  of  January  to  April  15,  1908;  but  it  is 
estimated  at  25,  which  gives  a  total  of  89  cases  in  the  epidemic  of  said  port. 

On  July  10,  1908,  the  lazaretto  of  La  Guaira  was  closed,  and  since  then  not 
one  single  case  of  plague  has  been  recorded,  nor  was  the  disease  found  in 
rodents.  The  epidemic  of  La  Guaira  lasted  6  months  only,  due  to  the  efforts 
exerted  by  the  Government,  nobly  assisted  by  the  merchants. 

In  the  plan  of  La  Guaira,  annexed  to  this  report,  are  marked  the  principal 
foci  of  the  plague. 

THE   EPIDEMIC   IN    CARACAS. 

The  proximity  of  La  Guaira  rendered  the  infection  of  Caracas  imminently 
dangerous,  and  all  preventive  measures  were  adopted  for  the  purpose  of 
warding  it  off;  railroad  traffic  was  interrupted  and  a  sanitary  cordon  was 
established  along  the  roads  traversing  the  Avila  Peak.  But,  in  spite  of  this 
measure,  several  persons  from  La  Guaira  were  smuggled  into  the  capital. 

The  first  case  appeared  on  April   18,    1908,  it  being  that  of  a  woman   who 
lived  in  the  neighborhood  of  the  railroad  station,  and  who  was  in  touch  with 
the  port  through   her   relatives   employed   in  the   railroad   line.     The   house   in 
which  that  woman  lived  is  marked  in  the  plan  with  a  special  sign. 
The  movement  of  the  epidemic  in  Caracas  was  as  follows : 

Total  number  of  cases  from  April  18,  1908,  to  October  2,  1909 107 

Men 83 

Women 24 

Patients  under  15   16 

Patients  over  15    91 

According  to  the  forms  of  the  disease : 

Bubonic   plague    83 

Bubonic  and  pneumonic  plague 12 

Pneumonic   plague    4 

Septicemic    plague     6 

Pneumonic  and   intestinal  plague 1 

Generalized    bubonic    plague 1 

Number  of  cases  cured,  62;  number  of  deaths,  45;  death  rate,  42  per  cent. 

According  to  months,  the  distribution  of  the  107  cases  reported  in  Caracas 
is  as  follows : 

Month.  ■  Cases. 

April 2 

May  1 

June 13 

July 24 

August 18 

September 12 

October 8 

November 0 

December 0 

"~78 

Month.  ^^^-  Cases. 

January  3 

February  1 

March  0 

April 0 

May  .  4 

June 12 

July  2 

August 5 

September 1 

October 1 


FOURTH   INTERNATIONAL  SANITARY  CONFERENCE.  203 

The  history  of  the  epidemic  in  Caracas  is  divided  into  three  periods :  First, 
from  April  18th  to  October  20,  1908;  second,  from  October  20,  1908,  to  May  20, 
1909;  third,  from  May  20th  to  October  2,  1909.  In  the  first  period  there  were 
78  cases  in  seven  months ;  in  the  second,  four  cases  in  seven  months ;  in  the 
third,  29  cases  in  six  months. 

This  intermittent  development  of  the  epidemic  shows  that  the  plague  has 
periods  of  recess  between  epochs  of  recrudescence,  and  that  the  disease  has 
disappeared  as  a  human  epidemic  for  several  months,  to  reappear  in  a  more 
benigji  form,  as  was  the  case  in  Caracas.  This  movement  of  plague  epidemic 
advises  that  the  fight  against  rats  should  never  be  abandoned,  as  the  disease 
persists  for  a  longer  time  in  those  rodents.  In  Caracas  the  campaign  against 
rats  was  never  interrupted  from  the  very  beginning  of  the  epidemic;  for  the 
destruction  of  these  dangerous  animals  we  have  availed  ourselves  of  all  known 
means,  giving  preference  to  the  measures  which  have  for  object  the  annihila- 
tion of  the  race  (see  general  ordinances  for  the  defence  of  Caracas  against 
plague,  annexes  B  and  C). 

In  the  present  moment  it  can  be  said  that  there  is  no  real  plague  epidemic 
in  Venezuela,  because  the  proportion  of  0.66  per  cent  of  infected  rats  and  the 
absence  of  new  cases  of  human  plague  clearly  show  that  the  disease  is  well 
under  way  of  completely  disappearing. 

The  plague  in  Caracas  has  not  reached  the  degree  of  lethality  which  is 
common  to  this  disease,  as  is  proven  by  the  death  rate,  42  per  cent,  and  the 
small  number  of  cases,  107,  in  a  population  of  100,000  inhabitants. 

In  our  country  a  fact  has  been  noticed  to  which  we  beg  to  call  the  attention 
of  the  honorable  members  of  this  assembly.  For  two  years  the  plague  has 
existed  in  the  Federal  District  (Caracas  and  La  Guaira),  which  is  the  commer- 
cial and  political  center  of  the  Republic;  during  that  time  there  was  no  inter- 
ruption in  the  communication  with  the  interior  nor  in  the  coastwise  traffic 
between  La  Guaira  and  other  ports  on  the  Caribbean  coast,  and,  in  spite  of 
it  all,  the  disease  did  not  appear  in  any  other  place  in  the  country,  neither 
in  the  ports  nor  in  the  interior  towns,  many  of  which  are  connected  with  the 
capital  by  railroad. 

This  confinement  of  the  epidemic  to  one  single  region  of  the  country  is 
due  to  the  combined  action  of  the  means  of  defense  enforced  by  the  sanitary 
authorities,  to  wit :  Rapid  isolation  of  all  patients ;  systematic  destruction  of 
rats ;  preventive  inoculation  of  Haffkine  lymph,  which  was  made  compulsory 
to  all  the  inhabitants,  and  especially  to  those  who,  by  reason  of  their  occupa- 
tion, had  to  enter  infected  cities. 

We  also  beg  to  call  attention  to  the  fact  that  there  has  not  been  observed 
in  Venezuela,  as  elsewhere,  an  excessive  mortality  among  rats  notwithstanding 
the  abundance  of  such  animals  in  the  country.  The  mildness  of  the  disease 
in  these  rodents  perhaps  accounts  for  the  limited  development  of  the  disease 
in  man. 

Besides,  all  cases  of  plague  were  among  persons  who  lived  under  unfavorable 
hygienic  conditions ;  such  persons  as  were  careful  of  their  personal  and  domestic 
hygiene  have  remained  immune.  This  fact  corroborates  the  theory  that  plague 
is  a  disease  prevalent  among  the  low  and  uncleanly  classes,  and  people  who 
live  in  dirty  dwellings.  The  contagion  can  be  avoided  by  means  of  the  simple 
observance   of  the   rules   of  personal   and   domestic   hygiene. 

PROPHYLAXIS. 

In  La  Guaira,  as  well  as  in  Caracas,  the  campaign  against  plague  was  estab- 
lished in  accordance  with  the  modern  scientific  principles  concerning  the  etiology 
of  the  plague,  preference  having  been  given  to  those  measures  which  gave  the 
best  results  in  other  places. 

This  campaign  was  based  upon  the  following  principal  points: 

First.  Isolation  of  the  patient  in  the  lazaretto  or  in  his  own  home  when  the 
enforcement  of  the  rules  for  isolation  was  assured. 

Second.  Immunization  of  all  tenants  of  infected  houses  and  houses  near 
thereto  by  means  of  the  Yersin  serum. 

Third.  Destruction  of  rats  in  the  said  houses  (this  operation  was  executed  by 
the  sanitary  squads). 

Fourth.  Immunization    of   all   the   inhabitants    of   the    city  by   means    of   the 


204  FOURTH    INTERNATIONAL  SANITARY   CONFERENCE. 

Haflfkine  lymph.  No  inhabitant  was  allowed  to  abandon  the  city  without  pro- 
ducing a  certificate  of  immunization. 

Fifth.  Systematic  sanitary  inspection  of  houses  by  health  inspectors  for  the 
purpose  of  investigating  the  sanitary  conditions  of  dwellings,  and  of  enforcing^ 
the  measures  enacted  by  the  Commission  of  Hygiene. 

Sixth.  Constant  persecution  of  rats  by  all  known  means  (see  annex  B). 

Seventh.  Careful  disinfection  of  infected  houses  and  others  near  thereto. 

For  the  purpose  of  enforcing  these  provisions  the  Commission  of  Public 
Hygiene  enacted  an  "Ordinance  for  the  Defence  of  Caracas  Against  Plague," 
and  prepared  the  instructions  to  the  sanitary  personnel  for  the  execution  of 
their  duties  (see  annexes  B  and  C). 

Thanks  to  the  activity  displayed  by  the  sanitary  authorities  and  to  the  sup- 
port given  them  by  the  Government,  the  merchants  and  other  citizens,  plague 
has  not  caused  in  our  country  the  ravages  that  it  has  spread  in  other  places. 
One  hundred  and  seven  cases  in  18  months  with  a  death  rate  of  42  per  cent 
is  a  sufficiently  satisfactory  result,  especially  if  we  take  into  consideration 
that  when  the  epidemic  first  broke  out  we  had  not  a  regular  sanitary  organiza- 
tion, and  everything  had  to  be  improvised. 

In  La  Guaira  the  epidemic  lasted  scarcely  six  months,  and  since  July  10, 
1908,  not  one  single  case  of  human  plague  has  appeared,  nor  has  the  disease 
been   found  in   rodents. 

TREATMENT. 

Our  plague  patients  have  been  systematically  treated  with  the  Yersin  serum; 
by  intravenous  or  subcutaneous  injections  at  high  doses,  according  to  the 
gravity  of  the  case.  In  mild  cases  colargol  was  used  with  very  satisfactory 
results. 

Besides  the  serotherapic  treatment,  and  following  the  advice  of  Prof.  S. 
Cantile,  of  London,  the  infected  ganglions,  especially  the  inguinal  ones,  were 
extirpated  in  the  beginning  of  the  development  of  the  disease.  When  the  extir- 
pation was  performed  before  the  first  48  hours  they  succeeded  in  decreasing 
the  death  rate  down  to  16.66  per  cent. 

No  treatment  is  available  in  serious  cases  of  pneumonic  and  septicemic  plague. 

PRESENT  CONDITION  OF  THE  EPIDEMIC. 

The  present  condition  of  the  epidemic  in  Venezuela  is  as  follows: 

La  Guaira. — The  disease  disappeared  from  this  port  on  July  10,  1908,  and 
since  then  not  one  single  case  of  human  plague  has  been  recorded,  nor  has  the 
disease  been  found  in  rats. 

Caracas. — The  epidemic  in  the  capital  is  now  under  control.  In  1909  only 
29  cases  of  human  plague  have  been  reported,  with  a  mortality  of  38  per  cent; 
the  proportion  of  infected  rats  is  0.66  per  cent.  As  the  campaign  against  these 
animals  is  carried  on  with  the  same  activity,  rats  from  all  points  of  the  city 
are  examined  in  the  bacteriological  laboratory,  and  the  inspection  of  houses  is 
constantly  made.  We  believe  that  we  can  consider  ourselves  protected  against 
a  reappearance  of  that  epidemic  disease. 

In  no  other  city  of  the  Republic  has  plague  ever  existed,  nor  does  it  exist  at 
present.  In  none  of  our  ports  is  there  to-day  any  infectious  quarantinable  dis- 
ease. Notwithstanding  the  satisfactory  sanitary  condition  of  the  Venezuelan 
coast,  the  health  authorities  of  Colon  treat  the  vessels  arriving  thereat  from  all 
ports  just  as  if  they  came  from  plague  infected  places.  This  procedure  is  not  in 
accord  with  the  stipulations  of  Articles  IX  of  the  Convention  of  Washington,  and 
we  beg  to  call  the  attention  of  this  learned  assembly  to  that  fact. 

YELLOW  FEVER. 

Although  vellow  fever  prevails  endemically  in  Venezuela,  not  only  in  some 
ports  of  the' littoral,  such  as  Puerto  Cabello,  Maracaibo,  Ciudad  Bolivar,  etc., 
but  also  in  towns  distant  from  the  coast,  even  in  some  high  altitudes,  as  Caracas, 
Valencia,  and  others,  we  must  recognize  that  the  disease  has  not,  hov/ever,  the 
gravity  nor  the  frequency  observed  in  other  countries  where  it  prevails. 

In  1907  yellow  fever  produced  throughout  the  Republic  a  total  of  31  deaths, 
of  which  l'6  were  reported  in  the  Federal  District,  2  in  the  State  of  Aragua;  8 
in  the  State  of  Bolivar ;  3  in  the  State  of  Merida ;  1  in  the  State  of  Miranda,  and 
1  in  the  State  of  Trujillo. 


FOURTH  INTERNATIONAL  SANITARY  CONFERENCE.  205 

The  recrudescence  of  the  disease  is  noticed  especially  in  certain  seasons  of 
the  year,  and  in  some  years  more  than  in  others. 

The  hot  months  and  unsettled  atmospheric  conditions  favor  the  development 
of  the  disease ;  and  the  facilities  of  communication  have  brought  the  infection 
to  places  where  it  was  unknown,  as  was  the  case  some  years  ago  in  certain 
towns  of  the  Andes  Mountains,  many  of  them  situated  at  a  high  altitude. 

Besides  the  measures  usually  taken  in  cases  of  transmissible  diseases,  the 
Commission  of  Public  Hygiene  has  recently  'nitiated  a  campaign  against  mos- 
quitoes and  distributed  a  pamphlet  with  popular  instructions  for  that  purpose; 
it  has  isolated  the  patients  with  a  view  to  protect  non-immune  persons,  and  it 
has  disinfected  all  infected  houses  and  neighboring  villages. 

The  Regulations  of  Maritime  Sanitary  Police  in  force  prescribe  the  treatment 
to  be  applied  in  our  ports  to  passengers,  baggage  and  merchandise  from  infected 
vessels,  in  accordance,  of  course,  with  the  Convention  of  Washington  of  1905, 
as  applied  to  international  relations,  as  well  as  to  the  coastwise  traffic. 

MALARIA. 

Malaria  is  our  great  national  endemic;  not  only  does  it  carry  away  many 
thousands  of  lives  every  year,  but  it  also  weakens  considerably  the  organism  of 
those  whom  it  does  not  kill,  leaving  them  in  a  state  of  physical  and  general  weak- 
ness which  impress  a  special  stamp  upon  those  unfortunate  inhabitants  of  the 
vast  regions  where  tliis  scourge  prevails.  This  disease  occurs  among  us  under  all 
its  forms  and  varieties. 

Wi*h  the  exception  of  some  high  lands  and  other  places  where  the  anopheles 
probably  does  not  exist,  as  is  the  case  in  Caracas,  for  instance,  the  disease 
prevails  in  almost  all  the  littoral  of  the  country,  and  very  especially  in  our  plains, 
which  are  immense  and  mostlj^  uninhabited,  and  which  is  in  its  greater  part  the 
cattle  region  of  Venezuela ;  its  area,  covering  many  thousands  of  square  kilome- 
ters, has  many  swamps   the  sanitation  of  which  is  practically  impossible. 

The  same  is  true  of  the  lands  traversed  by  our  rivers,  wherein  malaria  increases 
in  the  beginning  of  the  winter,  when  the  waters  start  to  withdraw,  which,  to- 
gether with  a  very  high  temperature,  creates  the  best  conditions  under  which 
the  disease  could  be  augmented  and  propagated. 

For  these  reasons  we  have  not  been  able  to  fight  malaria  successfully  up  to  the 
present  day,  and  also  on  account  of  the  expense  attached  to  such  a  campaign, 
which  could  not  be  borne  out  by  the  State  Government. 

Hemoglobinuric  fever,  considered  by  many  of  our  physicians  as  having  a  mala- 
rial origin,  has  caused  many  ravages  during  the  last  years,  especially  in  the 
States  of  Guarico  and  Apure,  although  only  since  1870  have  we  definite  informa- 
tion as  to  its  appearance  among  us,  and  it  was  spread  with  greater  force  after 
the  civil  war  of  1892. 

The  Society  of  Physicians  and  Surgeons  of  Caracas  issued  in  1894  a  circular 
to  the  physicians  of  the  towns  where  the  so-called  hematuric  fever  was  prevalent, 
and  some  interesting  papers  in  regard  to  the  subject  have  been  discussed  in 
the  National  Academy  of  Medicine,  on  various  occasions,  for  the  purpose  of 
elucidating  its  intimate  nature,  and  of  establishing  an  adequate  prophylaxis  and 
treatment. 

The  Commission  of  Public  Hygiene  has  recently  submitted  to  the  legislature 
a  bill  for  the  protection  of  public  health,  together  with  a  comprehensive  scheme 
in  regard  to  the  serious  problem  of  malaria,  and  the  raising  of  funds  for  the 
maintenance  of  a  campaign  against  malaria. 


It  may  be  stated  that  until  about  35  years  ago  beri-beri  was  a  disease  com- 
pletely unknown  in  Venezuela. 

The  first  cases  of  the  disease  appeared  in  Ciudad  Bolivar,  and  at  the  beginning 
they  were  not  diagnosed  because  the  disease  had  not  been  previously  observed. 

Dr.  Pedro  I.  Aguerrevere  published  in  1882  an  interesting  paper  in  regard  to 
the  subject,  and  it  was  he  who  for  the  first  time  explained  the  existence  of 
beri-beri  among  us. 

It  is  very  probable  that  the  importation  of  the  original  cases  was  perfected 
through  ships  arriving  at  Ciudad  Bolivar,  or,  what  is  perhaps  more  probable, 
through  the  Brazilian  frontier. 

Afterwards,  the  disease  w3s  propagated  to  the  States  of  Apure,  Guarico,  and 


206  FOURTH   INTERNATIONAL  SANITARY   CONFERENCE. 

Zanora,  reaching  also  the  State  of  Miranda,  which  bounds  with  the  Federal 
District. 

The  diversity  of  its  forms  sometimes  renders  the  differential  diagnosis 
difficult,  especially  in  certain  neuritis,  of  a  doxic  or  infected  nature,  and  even 
with  the  varieties  of  malarial  caquexia  and  probably  of  ankylostomiasis. 

Leprosy  was  first  introduced  in  Venezuela  in  1730  by  a  family  from  the 
Canary  Islands  residing  in  Cumana,  and  it  was  afterwards  transmitted  to  Caracas 
in  1740,  to  Maracaibo  in  1804,  and  to  Carupano  in  1820. 

At  present  it  prevails  in  some  points  of  the  eastern  coast  and  in  the  States 
along  the  Colombian  frontier. 

With  the  measures  that  have  been  taken  to  prevent  its  propagation,  and  with 
the  isolation  of  the  patients  in  especial  asylums,  its  range  has  not  increased, 
being  confined  to  certain  regions  only. 

There  are  two  leper  colonies,  one  in  Maiquetia,  near  Caracas,  and  another  in 
Providencia  Island,  near  Maracaibo,  State  of  Zulia.  In  these  establishments  all 
the  lepers  of  the  Republic  are  isolated,  and  the  total  of  patients  in  both  of  them 
varies  between  500  and  600. 

TRACHOMA. 

Since  1894  one  of  our  distinguished  oculists.  Dr.  Couturier,  called  the  atten- 
tion of  the  public  to  the  granular  conjunctivitis  and  to  the  frequency  with  which 
it  occurred  among  the  Assyrian  immigrants  arriving  at  our  ports. 

Those  Turks,  as  they  are  called  among  us,  live  conglomerated  in  small  filthy 
rooms,  but  the  disease  has  not  spread  much  and  its  cases  are  mostly  confined  to 
those  people  and  to  persons  equally  untidy. 

According  to  Doctor  Dagnino,  another  one  of  our  good  specialists,  the  majority 
of  our  streets  and  houses,  which  are  well  lighted  and  ventilated,  would  not  be 
adapted  to  the  propagation  of  trachoma,  the  favorite  places  of  which  are  dark 
room.s  and  damp  streets  where  the  sunlight  never  enters,  as  it  happens  in  certain 
districts  of  the  great  cities. 

The  Directors  of  Health  of  our  ports,  and  especially  of  La  Guaira,  at  which 
the  said  immigrants  arrive,  are  instructed  to  prevent  the  introduction  of  those 
suffering  from  this  disease,  and  several  individuals  have  been  returned  to  the 
country  of  origin  on  that  account. 

SMALLPOX. 

After  the  invasion  of  smallpox  in  the  16th  century,  through  the  port  of  Cara- 
balloda,  on  the  coast  of  La  Guaira,  which  decimated  the  native  population,  the 
disease  reappeared  in  1776,  entering  through  the  east  and  spreading  throughout 
a  great  portion  of  the  country,  where  it  made  thousands  of  victims,  due,  of 
course,  to  the  lack  of  preventive  measures  and  to  the  state  of  ignorance  in 
those  times. 

Since  the  beginning  of  the  last  century,  when  there  was  a  small  epidemic,  it 
may  be  said  that  smallpox  was  almost  unknown  in  Venezuela  until  1896,  in 
which  year  a  case  was  imported  through  Puerto  Cabello  that  caused  the  epidemic 
of  Valencia,  and  which  was  propagated  very  rapidly,  invading  m.any  towns 
of  the  Carbobo  State,  causing  a  great  mortality  among  the  patients,  due  to  the 
lack  of  immunization  and  the  scarcity  of  vaccine. 

When  the  disease  was  near  Caracas,  the  Pasteur  Laboratory,  a  private  institu- 
tion established  by  Drs.  Dominici,  Guardia,  Meier,  Rodriguez  and  Acosta  Ortiz, 
was  commissioned  by  the  National  Government  to  prepare  vaccine  in  large 
quantities,  and  it  is  thus  that  animal  vaccine  was  manufactured  for  the  first 
time  in  our  country.  The  virus  was  sent  throughout  the  whole  country,  after 
a  sufficient  amount  had  been  taken  for  the  inoculation  of  all  the  inhabitants  of 
Caracas  and  neighboring  towns,  where  the  epidemic  appeared  in  a  very  mild 
form. 

Since  then  the  virus  is  periodically  distributed  throughout  the  Republic  by  the 
Department  of  Interior  Affairs. 

Annex  E  contains  the  decree  making  vaccination  compulsory.  The  construc- 
tion and  organization  of  the  Institute  of  Vaccine,  referred  to  in  the  said  decree, 
will  soon  be  undertaken. 

DYSENTERY. 

Dysentery  of  amoebic  (Origin  is  frequent  in  some  regions  of  the  country  whose 
climatic  conditions  are  favorable  to  its  development. 


l^OURTH  INTERNATIONAL  SANITARY  CONFERENCE.  207 

The  same  is  true  of  tlie  tropical  abscess  of  the  liver,  due  to  the  same  etiological 
cause,  in  regard  to  which  malady  several  very  interesting  papers  have  been 
published  by  our  scientists,  most  of  them  from  the  School  of  the  Vargas  Hospital 
of  Caracas. 

CHOLERA. 

Cholera  is  unknown  in  Venezuela. 

MORTALITY    IN    CHILDREN. 

In  Venezuela  about  3,000  children  under  three  years  die  annually,  due  prin- 
cipally to  poor  food  among  the  low  classes  of  the  people. 

For  the  purpose  of  fighting  this  evil  the  institution  known  as  "La  Gota  de 
Leche"  (The  Drop  of  Milk)  was  founded  on  the  24th  of  July  of  this  year. 

The  creation  of  such  a  useful  philanthropic  establishment  is  due  to  the  private 
initiative  of  a  physician,  Dr.  J.  de  D.  Villegas  Ruiz,  and  has  the  support  of  the 
Government  and  several  private  persons.  It  has  now  400  children  in  its  lists. 
They  are  furnished  with  sterilized  milk  of  excellent  quality.  The  mothers  are 
advised  in  regard  to  the  rules  of  nursing  and  the  hygiene  of  the  child. 

A  board  composed  of  prominent  persons  of  both  sexes  manages  the  institu- 
tion, from  which  the  country  will  derive  great  benefit.  As  is  well  known,  infant 
mortality  is  one  of  the  principal  causes  that  hamper  the  normal  development 
of  communities,  especially  in  countries  which  have  not  as  yet  attained  a  high 
degree  of  civilization.  Besides  infantile  diarrhea,  tetanus  neonatorum  causes  a 
considerable  number  of  deaths  in  tropical  countries.  In  Venezuela  this  disease 
is  credited  in  our  demographic  statistics  with  4,000  deaths  per  annum.  This 
disease  has  no  other  cause  than  the  ignorance  of  mothers.  The  only  effective 
means  of  overcoming  that  cause  is  the  hygienic  education  of  women  in  public 
schools. 

TUBERCULOSIS. 

The  mortality  caused  by  tuberculosis  is  represented  by  a  number  of  about 
5,000  deaths  per  year. 

On  July  5,  1905,  Dr.  Andres  Herrera  Vegas  founded  the  Venezuelan  League 
against  Tuberculosis,  the  dispensary  of  which  was  opened  on  April  10,  1906. 

This  institution  has  the  support  of  prominent  persons  and  is  maintained  by 
private  individuals.  It  fulfills  its  mission  by  means  of  printed  propaganda  and 
popular  lectures ;  it  publishes  a  periodical  called  "La  Liga  Antituberculosa,"  edited 
by  Dr.  Herrera  Vegas  himself,  and  is  freely  distributed  to  the  public. 

"  Up  to  November  30th  of  the  present  year  the  dispensary  treated  4,000  patients, 
who  were  given  medicines  and  monetary  help,  and  whose  rooms  were  disin- 
fected. For  this  purpose  the  dispensary  is  provided  with  modern  disinfecting 
apparatus. 

The  4,000  patients  treated  in  the  dispensary  are  distributed  as  follows: 

According  to  age : 

From  0  to  1  year 313 

From  1  to  10  years 981 

From  11  to  20  years 1,004 

From  21  to  40  years 1,296 

Over  40  years  366 

4,000 

According  to  state : 

Married 1.568 

Single 2,006 

Widow 468 

4,000 

According  to  sex : 

Men 1.289 

Women 2,711 

4,000 


208  FOURTH    INTERNATIONAL   SANITARY   CONFERENCE. 

According  to  the  forms  of  the  disease : 

Affected  in  one  lung  617 

Affected  in  both  lungs 428 

Laryngeal   tuberculosis    48 

Intestinal  tuberculosis   104 

Other   forms    287 

Scrofula 1,946 

Rickets 176 

Suspected  and  under  observation 638 

ORGANIZATION  OF  THE  PUBLIC  HYGIENE. 

Public  hygiene  in  Venezuela  is  organized  as  follows : 

There  is  in  the  capital  of  the  Republic  a  commission  of  eight  members :  six 
physicians,  one  engineer  and  one  lawyer.  This  Commission  is  under  the  direct 
supervision  of  the  Department  of  Interior  Affairs.  The  Bureau  of  the  Com- 
mission is  divided  into  nine  sections,  to  wit :  First.  Maritime  Sanitary  Police — 
international  hygiene,  quarantine,  lazarettos,  etc.  Second.  General  Sanitation — 
sanitary  inspection  of  houses,  markets,  slaughter-houses,  etc.  Third.  Special  Dis- 
infection— contagious  diseases,  distribution  of  serum  and  vaccine,  etc.  Fourth. 
Bacteriology — microscopical  analysis,  preparation  of  serums  and  vaccine,  etc. 
Fifth.  Chemistry — chemical  analysis  of  water,  food  products,  beverages,  etc. 
Sixth.  Engineering — construction  of  buildings,  sewers,  aqueducts,  pavements,  etc. 
Seventh.  Demographic  Statistics.  Eighth.  Sanitary  Legislation  and  Social  Hy- 
giene. Ninth.  Oifice  of  the  Secretary  and  General  Administration.  Each  of  these 
divisions  is  under  a  member  of  the  Commission. 

The  central  office  employs  official  health  officers,  sanitary  inspectors  and  sani- 
tary squads,  charged  with  the  inspection  of  houses,  disinfection  of  dwellings,  de- 
struction of  rats  and  mosquitoes,  and  with  the  enforcement  of  provisions  enacted 
by  the  Commission  of  Public  Hygiene. 

The  Commission  has  a  disinfecting  station  provided  with  two  Clayton  ap- 
paratus, type  H,  three  formol-steam  generators,  three  antiseptic  sprays  and  three 
whitewashing  sprays. 

This  station  is  managed  by  a  physician  as  chief  of  the  service.  He  has 
under  him  a  mechanician  for  the  operation  of  the  apparatus  and  a  special  squad 
of  operators  who  are  skillful  in  disinfections.  As  soon  as  a  case  of  any  disease 
the  reporting  of  which  is  compulsory  is  known  the  disinfection  of  the  house  is 
made  and  isolation  measures  taken  in  accordance  with  each  case. 

Each  sanitary  inspector  visits  every  day  fifteen  houses  of  those  within  his 
jurisdiction  and  fills  a  special  bulletin  in  which  are  stated  the  sanitary  condi- 
tions of  each  dwelling.  The  respective  health  officer  informs  the  civil  authority 
of  the  town  as  to  the  sanitary  measures  needed  in  each  house,  and  compels  the 
owner  thereof  to  carry  them  out  within  a  fixed  period  which  cannot  be  extended. 

In  this  inspection  of  houses  destruction  is  carefully  made  of  rats  and 
mosquitoes. 

The  Commission  of  Public  Hygiene  has  now  under  consideration  the  sanitary 
regulation  of  markets,  slaughter  houses,  dairies,  schools,  etc. ;  the  Commission 
did  not  carry  out  this  important  work  before  because  the  campaign  against  the 
plague  necessitated  its  undivided  attention. 

It  is  also  studying  the  proper  measures  for  the  eradication  of  malaria,  dysen- 
tery, yellow  fever,  tetanus,  and  other  diseases  peculiar  to  intertropical  countries. 

COMPin.SORY    REGISTRATION    OF    INFECTIOUS    DISEASES. 

An  executive  decree  provides  for  the  compulsory  registration  of  the  following 
diseases :  Typhoid  fever,  exanthematic  typhus,  malaria,  smallpox,  varioloid, 
measles,  scarlet  fever,  whooping-cough,  dyphtheria,  miliary  fever,  Asiatic  and 
nostras  cholera,  epidemic  dysentery,  plague,  yellow  fever,^  leprosy,  erysipelas, 
beri-beri,  trachoma,  filariosis,  puerperal  infections,  ophthalmia  neonatorum.  The 
registration  of  tuberculosis,  grippe,  syphilis  and  enteritis  is  discretional  (see 
annex  D). 

SANITATION   OF  PORTS. 

Venezuela  has  a  law  of  Maritime  Sanitary  Police  based  upon  the  prescriptions 
of  the  Convention  of  Washington. 


fOURTH  INTERNATIONAL  SANITARY  CONFERENCE.  200 

By  virtue  of  this  law  the  littoral  of  the  Republic  is  divided  into  sanitary  zones 
which  are  in  turn  subdivided  into  health  agencies.  In  each  port  of  entry  there 
is  a  health  board  composed  of  a  physician  as  Director  of  Health,  the  Collector 
of  Customs,  the  Civil  Chief  of  the  District,  the  President  of  the  Municipal 
Council,  and  a  merchant  appointed  by  the  Chamber  of  Commerce  (see  annex  A). 

There  are  now  under  construction  disinfecting  stations  for  the  ports  of  La 
Guaira,  Puerto  Cabello,  and  Carupano,  provided  with  Clayton  apparatus  and 
formol  generators  for  the  systematic  disinfection  of  baggage  belonging  to 
passengers  arriving  at  or  leaving  the  country. 

DEMOGRAPHIC    STATISTICS. 

In  Venezuela  the  diseases  which  have  caused  the  greatest  number  of  deaths 
are :  Malaria,  tuberculosis,  dysentery,  tetanus,  infantile  diarrhea,  ankylosto- 
miasis, yellow  fever,  etc.  Yellow  fever,  although  endemic  in  the  coast  region, 
does  not  contribute  noticeably  to  increase  the  mortality;  there  are  scarcely  thirty 
deaths  from  yellow  fever  annually  throughout  the  country  (see  annex  F). 

The  most  deathly  of  all  tropical  endemics  is  malaria.  In  Venezuela  it  is 
credited  with  one-fifth  of  the  general  mortality.  Malaria  is  the  one  great 
enemy  of  progress  in  tropical  countries,  not  only  on  account  of  the  number  of 
deaths  which  it  causes,  but  also  because  its  chronic  forms  convert  the  patients 
into  mere  valetudinarians.  The  Commission  of  Hygiene  is  at  present  studying 
practical  means  of  fighting  that  dreadful  scourge;  nevertheless,  it  is  well  aware 
of  the  great  difficulties  which  confront  it  in  the  undertaking  of  such  a  task, 
because  the  campaign  against  this  endemic  must  necessarily  include  an  area 
of  over  400,000  square  kilometers  covered  by  our  plains,  wherein  malaria  is 
endemic. 

The  general  movement  of  the  population  during  the  last  four  years  was  as 
follows : 

Difference  in 
Year.  Births.  Deaths.  favor  of  births. 


1905 

68,978 

58,343 

10,635 

1906 

70,221 

53,801 

16,420 

1907 

74,324 

52,310 

22,926 

1908 

71,033 

57,088 

13,033 

The  annual  averages  are:  Nativity,  31.1  per  thousand;  mortality,  25  per  thou- 
sand; marriage,  2.6  per  thousand. 

ANNEXES   TO   REPORT. 

Annex  A. — Law  of  Maritime  Sanitary  Police. 

Annex  B. — General  Ordinances  for  the  Defence  of  Caracas  against  Plague. 

Annex  C. — Instructions  to  Sanitary  Officers. 

Annex  D. — Decree  Making  the  Registration  of  Infectious  Diseases  Compulsory. 

Annex  E. — Decree  Making  Vaccination  Compulsory. 

Annex  F. — Venezuelan  Demography. 

PLANS. 

Topographic  plan  of  the  city  of  Caracas  showing  the  plague  foci  in  the  epidemic 
of  1908-9. 

Topographic  plans  of  the  cities  of  La  Guaira  and  Miqueti,  showing  the  plague 
foci  during  the  epidemic  of  1908. 


COLUMBIA  UNIVERSITY  LIBRARIES 

This    book    is    due    on    the    date    indicated    below,    or    at    the 
expiration   of   a   definite    period    after   the  date  of  borrowing,   as 
provided    by    the    hbrary    rules    or    by    special    arrangement    with 
the  Librarian  in  charge. 

DATE    BORROWED 

DATE    DUE 

DATE    BORROWED 

DATE    DUE 

C28(955)100MEE 

RA422 
P19 

1909/10 
Pan  Amei'ican  Sanitarv  Conference. 

4^  San  Jose,  Costa  Rica,  1909- 

1910. 

Transactions, 


/^PR  2  5  !930 


